Abstract
BackgroundThe benefits of postoperative adjuvant chemoradiotherapy (CRT) for pancreatic cancer remain controversial. The purpose of this study is to determine if adjuvant CRT can improve the overall survival of postoperative pancreatic cancer patients compared to adjuvant chemotherapy (CT).MethodsPatients with resected pancreas adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016). Multivariate Cox regression was used to determine the factors related to survival rate. Selection bias was reduced to a minimum through propensity matching analysis. Subgroup analyses by clinical characteristics were performed.ResultsThis study identified 10,097 patients who received adjuvant CT (n = 5,454) or adjuvant CRT (n = 4,643). On multivariate analysis, age, sex, tumor size, site, grade, stage, T stage, and lymph node metastasis were independent risk factors for OS. The basic clinical characteristics were well balanced after propensity matching. After propensity matching, CRT can improve the survival rate compared with CT [median OS: 22 months vs 23 months (HR, 0.928; 95% CI, 0.881–0.977; P = 0.004)]. Subgroup analysis indicated that the survival benefit of adjuvant chemoradiotherapy was more significant in patients with female (HR, 0.860; 95% CI, 0.798–0.926; P = 0.005 for interaction) or T3 (HR, 0.905; 95% CI, 0.855–0.957; P = 0.04 for interaction) or lymph nodes positive (HR, 0.883; 95% CI, 0.832–0.938; P = 0.005 for interaction).ConclusionAdjuvant CRT was associated with improved survival compared with adjuvant CT in patients with resection of pancreatic ductal adenocarcinoma. The benefit was more significant in patients with female or T3 or lymph nodes positive.
Highlights
The benefits of postoperative adjuvant chemoradiotherapy (CRT) for pancreatic cancer remain controversial
We retrospectively studied the survival outcomes of adjuvant therapy in patients with pancreatic cancer diagnosed in the SEER database
Most of the tumors occurred in the head of the pancreas (73.6%), and most of them were between 2 and 4 cm (58.3%) in size
Summary
The benefits of postoperative adjuvant chemoradiotherapy (CRT) for pancreatic cancer remain controversial. The purpose of this study is to determine if adjuvant CRT can improve the overall survival of postoperative pancreatic cancer patients compared to adjuvant chemotherapy (CT). Pancreatic cancer is one of the most aggressive tumors. The vast majority of patients with pancreatic cancer present as locally advanced unresectable tumors at the first diagnosis, and their clinical treatment is complicated and the prognosis is poor. Surgical resection is performed, most patients have local recurrence or distant metastasis within 2 years [6–8], so postoperative systemic and local adjuvant therapy after surgery is important. Multiple studies have confirmed the survival benefits of adjuvant CT in pancreatic cancer [9–12]. The reason for the contradiction may be that the lack of a standardized plan for adjuvant CRT leads to defects in the design and implementation of early clinical trials, as well as the use of antiquated techniques [16–19]
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