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Lin ZB, Song JY, Li AC, Chen C, Huang XX, Xu BH. The benefit of adjuvant radiotherapy on overall survival in resected stage I to II pancreatic cancer: A propensity-adjusted analysis. PLoS One 2020; 15:e0243170. [PMID: 33315874 PMCID: PMC7735624 DOI: 10.1371/journal.pone.0243170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The survival time of patients with early pancreatic cancer (PC) is still disappointing, even after surgical resection. PC has an extremely poor prognosis. Herein, we aimed to investigate the survival effect of postoperative radiotherapy (PORT) on resected stage I to II PC. MATERIAL AND METHODS A large eligible sample of patients was identified from 2010 to 2015 from the Surveillance, Epidemiology, and End Results (SEER) registry. Survival analysis was conducted to evaluate the efficiency of PORT. Propensity score matching (PSM) analysis was used to reduce selection bias and to make the groups comparable. RESULTS A total of 3219 patients with resected stage I to II PC was included after rigid screening. The median overall survival (OS) was 26 months with PORT (n = 1055) versus 21 months with non-PORT (n = 2164) before matching (p<0.001). By multivariable analysis, PORT remained a favorable prognostic predictor for OS. In PSM analysis, receiving PORT was associated with improved OS (median, 26 months vs. 23 months; at 2 years, 51.7% vs. 46.7%; at 5 years, 23.3% vs. 17.4% (P = 0.006). After further meticulous exploration, only the stage IIB subgroup benefited from PORT (p<0.001). This result was due to the positive lymph node state (N+), whose mortality risk was cut by 23.4% (p<0.001) by PORT. CONCLUSION Addition of PORT to the treatment of patients with resected stage I to II PC conveys a survival benefit, particularly among those with N-positive or stage IIB disease.
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Affiliation(s)
- Zhuang-Bin Lin
- The Graduate School of Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Jian-Yuan Song
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - An-Chuan Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Cheng Chen
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Xiao-Xue Huang
- The Graduate School of Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Ben-Hua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- * E-mail:
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Raoof M, Blakely AM, Melstrom LG, Lee B, Warner SG, Chung V, Singh G, Chen Y, Fong Y. Adjuvant chemotherapy versus chemoradiation in high-risk pancreatic adenocarcinoma: A propensity score-matched analysis. Cancer Med 2019; 8:5881-5890. [PMID: 31414566 PMCID: PMC6792522 DOI: 10.1002/cam4.2491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The American Society of Clinical Oncology guidelines recommend adjuvant chemoradiation (ACR) for margin-positive (R1) and/or node-positive (N+) pancreatic cancers. Our goal was to investigate if there is evidence of superiority of adjuvant chemoradiation (ACR) over adjuvant chemotherapy (AC). METHODS We utilized data from the National Cancer Database (NCDB) for N+ and/or R1 pancreatic adenocarcinoma patients diagnosed from 2004 to 2012 who underwent ACR or AC. Patients who received neoadjuvant radiation, no adjuvant treatment, or adjuvant radiation alone were excluded. Propensity score nearest-neighbor 1:1 matching (PSM) was performed between ACR and AC groups based on age, sex, race, insurance, year of diagnosis, comorbidities, tumor site and size, T-stage, nodal status, margin status, grade, and treatment facility. Primary outcome was overall survival (OS). RESULTS A total of 8297 patients were eligible. After PSM, two well-balanced groups of 3244 patients each were analyzed. ACR resulted in superior OS compared with AC alone (Hazard ratio [HR] 0.83, 95% CI 0.79-0.87; median OS 22 vs 19 months, P < .0001). Subset analyses demonstrated OS benefit of ACR compared with AC in N+, R0 patients (HR: 0.82, 95% CI 0.77-0.88; Median OS 24 vs 20 months, P < .001) as well as N+, R1 patients (HR: 0.77, 95% CI 0.68-0.87; Median OS 17 vs 15 months, P < .001); but not in node-negative, R1 patients (HR: 1.12, 95% CI 0.84-1.48; Median OS 18 vs 22 months, P = .63). CONCLUSION The addition of radiation to AC was associated with a clinically small but meaningful increase in survival of patients undergoing curative-intent pancreatic resections. This association was not evident in patients with microscopically positive margins but node-negative disease and larger studies will be needed.
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Affiliation(s)
- Mustafa Raoof
- Department of SurgeryCity of Hope National Medical CenterDuarteCalifornia
| | - Andrew M. Blakely
- Department of SurgeryCity of Hope National Medical CenterDuarteCalifornia
| | - Laleh G. Melstrom
- Department of SurgeryCity of Hope National Medical CenterDuarteCalifornia
| | - Byrne Lee
- Department of SurgeryCity of Hope National Medical CenterDuarteCalifornia
| | - Susanne G. Warner
- Department of SurgeryCity of Hope National Medical CenterDuarteCalifornia
| | - Vincent Chung
- Department of Medical OncologyCity of Hope National Medical CenterDuarteCalifornia
| | - Gagandeep Singh
- Department of SurgeryCity of Hope National Medical CenterDuarteCalifornia
| | - Yi‐Jen Chen
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCalifornia
| | - Yuman Fong
- Department of SurgeryCity of Hope National Medical CenterDuarteCalifornia
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Nagakawa Y, Sahara Y, Hosokawa Y, Murakami Y, Yamaue H, Satoi S, Unno M, Isaji S, Endo I, Sho M, Fujii T, Takishita C, Hijikata Y, Suzuki S, Kawachi S, Katsumata K, Ohta T, Nagakawa T, Tsuchida A. Clinical Impact of Neoadjuvant Chemotherapy and Chemoradiotherapy in Borderline Resectable Pancreatic Cancer: Analysis of 884 Patients at Facilities Specializing in Pancreatic Surgery. Ann Surg Oncol 2019; 26:1629-1636. [PMID: 30610555 DOI: 10.1245/s10434-018-07131-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The efficacy of neoadjuvant therapy (NAT), including neoadjuvant chemotherapy (NAC) and neoadjuvant chemo-radiotherapy (NACRT), for patients with borderline resectable pancreatic cancer (BRPC) has not been elucidated. This study aimed to clarify the efficacy of NAC and NACRT for patients with BRPC. METHODS The study analyzed the treatment outcomes of 884 patients treated for BRPC from 2011 to 2013. Treatment results were compared between upfront surgery and NAT and between NAC and NACRT using propensity score-matching analysis. Overall survival (OS) was calculated via intention-to-treat analyses. RESULTS The overall resection rates for the patients who underwent NAT were significantly lower than for the patients who underwent upfront surgery (75.1% vs 93.3%; p < 0.001). However, the R0 resection rate was significantly higher for NAT than for upfront surgery (p < 0.001). Additionally, the OS for the patients who received NAT was significantly longer than for those who underwent upfront surgery (median survival time [MST], 25.7 vs 19.0 months; p = 0.015). The lymph node rate for the patients with NACRT was significantly lower than for those who underwent NAC (p < 0.001). However, the resection rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.041). The local recurrence rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.002). However, OS did not differ significantly between NAC and NACRT (MST, 29.2 vs 22.5 months; p = 0.130). CONCLUSIONS The study showed that NAT has potential benefit for patients with BRPC. Compared with NAC, NACRT decreased the rates for lymph node metastasis and local recurrence but did not improve the prognosis.
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Affiliation(s)
- Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan.
| | - Yatsuka Sahara
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yuichi Hosokawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yoshiaki Murakami
- Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Yamaue
- Department of Gastroenterological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Michiaki Unno
- Department of Hepatobiliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shuji Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Chie Takishita
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yosuke Hijikata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Shuji Suzuki
- Department of Gastroenterological Surgery, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
| | - Shigeyuki Kawachi
- Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Tetsuo Ohta
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Takukazu Nagakawa
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan
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