Abstract
BackgroundThe 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 methodsA 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.ResultsA 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.ConclusionAddition 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.
Highlights
Pancreatic cancer (PC) has emerged as the deadliest malignant cancer in the United States, with the lowest five-year overall survival rate of only 9%
Most precise, and most comprehensive analysis based on SEER data in resected stage I to II pancreatic cancer patients whose postoperative chemotherapy information was available to explore the role of postoperative radiotherapy (PORT) on survival in this population
Results demonstrated that addition of PORT was associated with an overall survival (OS) benefit in resected stage I to II PC on the whole
Summary
Pancreatic cancer (PC) has emerged as the deadliest malignant cancer in the United States, with the lowest five-year overall survival rate of only 9%. The role of radiation is being evaluated in ongoing clinical trials Previous studies, such as the GITSG 9173 and ESPAC-1 trials, have produced controversial results, resulting in different treatment concepts between Europe and the United States [4, 5]. Even accounting for those with R1 resection and lymph node positive disease who have a higher risk for recurrence [6, 7], when considering medical costs, side effects of radiation, patient tolerance, impacts on quality of life and unsubstantiated potential benefits, the net benefit to survival from added postoperative radiotherapy (PORT) is uncertain. We aimed to investigate the survival effect of postoperative radiotherapy (PORT) on resected stage I to II PC
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