Abstract
The benefit of combining postoperative radiation therapy (PORT) with chemotherapy for resected patients with pancreatic adenocarcinoma is controversial. We sought to determine the effects of PORT on survival in patients with pancreatic adenocarcinoma who underwent primary site surgery. Patients with pancreatic adenocarcinoma receiving primary tumor surgery between 1988 and 2012 were identified from the Surveillance, Epidemiology and End Results (SEER) database. We estimated the association between PORT and other clinicopathologic factors and survival. In total, 5304 patients were identified who underwent pancreatic resection including 2093 patients who had PORT and 3211 patients who had no PORT. Median overall, cancer-specific, and other-cause survival were 19.0, 20.0, and 196.0 months, respectively, with PORT versus 14.0, 15.0, and 163.0 months, respectively, without PORT (all P < 0.001). Subset analysis revealed that the benefit of PORT was limited to patients with N1 disease. Median overall, cancer-specific, and other-cause survival for patients with N1 disease were 18.0, 18.0, and NA months, respectively, with PORT versus 12.0, 13.0, and 154.0 months, respectively, without PORT (all P < 0.001). Regardless the number of positive lymph node count (PLN) and lymph node ratio (LNR), PORT was always associated with increased survival on multivariate analysis in patients with N1 disease (all P < 0.001). In summary, survival benefits might be obtained from PORT on lymph node positive patients with pancreatic adenocarcinoma.
Highlights
In 2015, an estimated 48960 individuals were diagnosed with pancreatic cancer in the United States and approximately 40560 individuals died from the disease [1]
Regardless the number of positive lymph node count (PLN) and lymph node ratio (LNR), postoperative radiation therapy (PORT) was always associated with increased survival on multivariate analysis in patients with N1 disease
Our study shows that PORT is associated with better overall and cancer-specific survival in pN1 patients with pancreatic adenocarcinoma
Summary
In 2015, an estimated 48960 individuals were diagnosed with pancreatic cancer in the United States and approximately 40560 individuals died from the disease [1]. The 5-year survival rate for patients with all stages of pancreatic cancer is 7.2% [1]. It has been suggested that subsets of patients with pancreatic cancer, such as patients with positive lymph nodes, may be more likely to benefit from adjuvant chemoradiation. A meta-analysis of 4 randomized controlled trials found that adjuvant chemoradiation had a similar lack of benefit in lymph node-positive and -negative patients [2]. Previous analyses of the SEER database suggested an advantage for adjuvant radiation therapy after pancreatic tumor resection [4,5,6].Subgroup analysis revealed that the benefit of PORT was limited to lymph node-positive (N1) patients [6]. We performed a retrospective study to evaluate the association of PORT and survival in patients with pancreatic adenocarcinoma receiving standard therapy
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