Neoadjuvant radiation followed by resection versus upfront resection for locally advanced pancreatic cancer patients: a propensity score matched analysis.

Guodong Chen,Geng Liu,Kaiqiang Wang,Jinjin Sun,Xing Chen

doi:10.18632/oncotarget.18091

Guodong Chen, Geng Liu + Show 3 more

Open Access

https://doi.org/10.18632/oncotarget.18091

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Journal: Oncotarget	Publication Date: May 23, 2017
Citations: 6	License type: cc-by

Affiliation: Second Hospital of Tianjin Medical University

Abstract

Background and aimTo compare cancer-specific survival (CSS) between patients who received neoadjuvant radiation followed by resection (NRR) and those who received upfront resection (UR) for locally advanced pancreatic cancer (LAPC).MethodsA total of 772 LAPC patients who underwent curative-intent surgical resection with or without neoadjuvant radiation from 2004 to 2013 were identified from the Surveillance, Epidemiology, and End Result (SEER) database. Propensity score matching (PSM) was conducted to eliminate possible bias. Kaplan-Meier method was used to analyze long-term outcome. Independent risk factors of CSS were predicted by Cox proportional hazards model. Subgroup analyses were done according to 5 variables.ResultsThe propensity score model matched 196 patients from the whole cohort. Neoadjuvant radiation was an independent predictor of CSS no matter before or after PSM. After PSM, the 1-, 3-, 5-year CSS rates of NRR group were 82.7%, 39.2% and 17.1%, while 64.3%, 19.9% and 12.4% for UR group. The median CSS for NRR group was 25 months, while 17 months for UR group. In subgroup analyses, CSS rates or median CSS of NRR group were still superior to those of UR group in married, unmarried, pancreatic adenocarcinoma, G1+G2, G3+G4, N0 stage, N1 stage and M0 stage subgroups, but no differences were found in other histological types and M1 stage subgroups. Other predictors of CSS included histological type, tumor grade and marital status.ConclusionsNeoadjuvant radiation followed by resection has a significant survival benefit compared with upfront resection in LAPC patients. Therapeutic strategy for LAPC patients should be further explored.

Highlights

According to the latest statistics, cancer of pancreas was the fourth cause of death among all types of cancer, and 45090 patients were estimated to die of this malignancy in 2017 in the USA [1]
cancer-specific survival (CSS) rates or median CSS of neoadjuvant radiation followed by resection (NRR) group were still superior to those of upfront resection (UR) group in married, unmarried, pancreatic adenocarcinoma, G1+G2, G3+G4, N0 stage, N1 stage and M0 stage subgroups, but no differences were found in other histological types and M1 stage subgroups
Neoadjuvant radiation followed by resection has a significant survival benefit compared with upfront resection in locally advanced pancreatic cancer (LAPC) patients

Summary

Introduction

According to the latest statistics, cancer of pancreas was the fourth cause of death among all types of cancer, and 45090 patients were estimated to die of this malignancy in 2017 in the USA [1]. One cause of poor survival was due to lack of specific signs and symptoms, and a considerable part of patients presented with advanced or metastatic disease. Treatment strategies for early resectable and metastatic disease were relatively clear and definite, namely resection plus sequential adjuvant chemotherapy for the former and systemic chemotherapy or best supportive care for the latter [2]. That was not the case for locally advanced patients (T4, with celiac trunk or superior mesenteric artery involved). Systemic chemotherapy and support care were recommended for those patients [2], surgeons never stopped trying surgical resection. To compare cancer-specific survival (CSS) between patients who received neoadjuvant radiation followed by resection (NRR) and those who received upfront resection (UR) for locally advanced pancreatic cancer (LAPC)

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Results

Conclusion