{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:59:38Z","timestamp":1790621978512,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Neoadjuvant therapy for pancreatic adenocarcinoma (PDAC) has evolved from single\u2010agent to multi\u2010agent approaches, largely informed by metastatic disease studies demonstrating improved survival; albeit at the price of increased toxicity. It remains unclear how response to varied neoadjuvant regimens impact survival. We hypothesized that tumor response to different neoadjuvant approaches reflects underlying tumor biology, and achieving a pathologic complete response (pCR) with single\u2010agent neoadjuvant may signal favorable biology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult PDAC patients (2010\u20132021) who received neoadjuvant therapy were identified in the National Cancer Database. Tumor response was categorized as pCR (pT0N0), moderate (\u2265\u20092 T\u2010stage reduction), or minimal\/no response (\u2264\u20091 T\u2010stage reduction). Patients with stage IV disease, margin positive, or nodal involvement on final pathology were excluded; sensitivity analyses including these patients were performed. Neoadjuvant regimens were classified as single\u2010agent, multi\u2010agent, or multi\u2010agent therapy plus adjuvant chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1923 patients, 9.8% achieved pCR, 19.1% had moderate response and 71.1% had minimal\/no response. The 3\u2010year overall survival (OS) was 74% [68\u201381] for pCR, 56% [51\u201362] for moderate, and 50% [47\u201352] for minimal\/no response. Notably, 11% of pCR patients received single\u2010agent therapy and had a 3\u2010year OS comparable to those who received more intensive regimens, even after adjusting for confounders. Conversely, single\u2010agent therapy in moderate or minimal\/no responders was associated with significantly worse survival. Sensitivity analyses including patients with nodal metastasis and positive margins demonstrated consistent trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most PDAC patients benefit from multi\u2010agent neoadjuvant, although a small subset achieve pCR with single\u2010agent therapy and experience excellent outcomes. Response to varied neoadjuvant approaches merits further investigation in biomarker\u2010driven studies and may inform opportunities for therapy personalization in appropriately selected PDAC patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70329","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:21:41Z","timestamp":1788499301000},"page":"631-638","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Neoadjuvant Approach and Tumor Response on Survival in Pancreatic Adenocarcinoma"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1960-5790","authenticated-orcid":false,"given":"Mohammed O.","family":"Suraju","sequence":"first","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Longbottom","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine A.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"Hayes","sequence":"additional","affiliation":[{"name":"Carver College of Medicine University of Iowa  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiers","family":"Brevik","sequence":"additional","affiliation":[{"name":"Department of Biology University of Iowa  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean Y.","family":"Kim","sequence":"additional","affiliation":[{"name":"Carver College of Medicine University of Iowa  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Goffredo","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Minnesota  Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Hassan","sequence":"additional","affiliation":[{"name":"Mercy Hospital Cedar Rapids Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Aziz","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos H. F.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics  Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2015.0668"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.13027"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2019.3337"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002234"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000971"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2023.06.018"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000095"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2217\/fon.15.335"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011923"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(25)00363-8"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/03000605221093225"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-99647-5"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2024.5191"},{"key":"e_1_2_7_15_1","unstructured":"N. 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