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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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Xu HX, Li S, Wu CT, Qi ZH, Wang WQ, Jin W, Gao HL, Zhang SR, Xu JZ, Liu C, Long J, Xu J, Ni QX, Yu XJ, Liu L. Postoperative serum CA19-9, CEA and CA125 predicts the response to adjuvant chemoradiotherapy following radical resection in pancreatic adenocarcinoma. Pancreatology 2018; 18:671-677. [PMID: 30153903 DOI: 10.1016/j.pan.2018.05.479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the prediction of benefits from adjuvant chemoradiotherapy by postoperative serum CA19-9, CA125 and CEA. METHODS The relations between benefits from adjuvant chemoradiotherapy and levels of postoperative serum CA19-9, CA125 and CEA were investigated in 804 pancreatic adenocarcinoma patients who received radical resection. RESULTS Adjuvant chemoradiotherapy was an independent factor for late recurrence [12.2 vs. 8.5 months, P = 0.001 for recurrence free survival (RFS)] and long survival [23.7 vs. 17.0 months, P < 0.001 for overall survival (OS)] in resected pancreatic adenocarcinoma. Postoperative serum CA19-9, CA125 and CEA were independent risk predictors for poor surgical outcome in pancreatic adenocarcinoma (P < 0.001 for all). Adjuvant chemradiotherapy (hazard ratio: 0.359, 95% confidence interval: 0.253-0.510, P < 0.001 for OS; hazard ratio: 0.522, 95% confidence interval: 0.387-0.705, P < 0.001 for RFS) were confirmed to improve the surgical outcome in patients with abnormal levels of any one of the three postoperative markers, but not in patients with normal levels of the three postoperative markers. In the subgroup of patients with negative lymph node, its improvement of surgical outcome was also significant in patients with abnormal levels of any one of postoperative serum CA19-9, CA125 and CEA (hazard ratio: 0.412, 95% confidence interval: 0.244-0.698, P = 0.001 for OS; hazard ratio: 0.546, 95% confidence interval: 0.352-0.847, P = 0.007 for RFS). CONCLUSION Postoperative serum CA19-9, CA125 and CEA could serve as predictors of response for adjuvant chemoradiotherapy even if the status of lymph nodes is negative.
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Affiliation(s)
- Hua-Xiang Xu
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Shuo Li
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Chun-Tao Wu
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Zi-Hao Qi
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Wen-Quan Wang
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Wei Jin
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - He-Li Gao
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Shi-Rong Zhang
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Jin-Zhi Xu
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Chen Liu
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Jiang Long
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Jin Xu
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Quan-Xing Ni
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China
| | - Xian-Jun Yu
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China.
| | - Liang Liu
- Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai, 20032, PR China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China.
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