Stessin Alexander M, Meyer Joshua E, Sherr David L
Tri-Institutional MD-PhD Program, New York, NY, USA.
Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):1128-33. doi: 10.1016/j.ijrobp.2008.02.065. Epub 2008 Jun 4.
Cancer of the exocrine pancreas is the fifth leading cause of cancer death in the United States. Neoadjuvant chemoradiation has been investigated in several trials as a strategy for downstaging locally advanced disease to resectability. The aim of the present study is to examine the effect of neoadjuvant radiation therapy (RT) vs. other treatments on long-term survival for patients with resectable pancreatic cancer in a large population-based sample group.
The Surveillance, Epidemiology, and End Results (SEER) registry database (1994-2003) was queried for cases of surgically resected pancreatic cancer. Retrospective analysis was performed. The endpoint of the study was overall survival.
Using Kaplan-Meier analysis we found that the median overall survival of patients receiving neoadjuvant RT was 23 months vs. 12 months with no RT and 17 months with adjuvant RT. Using Cox regression and controlling for independent covariates (age, sex, stage, grade, and year of diagnosis), we found that neoadjuvant RT results in significantly higher rates of survival than other treatments (hazard ratio [HR], 0.55; 95% confidence interval, 0.38-0.79; p = 0.001). Specifically comparing adjuvant with neoadjuvant RT, we found a significantly lower HR for death in patients receiving neoadjuvant RT rather than adjuvant RT (HR, 0.63; 95% confidence interval, 0.45-0.90; p = 0.03).
This analysis of SEER data showed a survival benefit for the use of neoadjuvant RT over surgery alone or surgery with adjuvant RT in treating pancreatic cancer. Therapeutic strategies that use neoadjuvant RT should be further explored for patients with resectable pancreatic cancer.
胰腺外分泌癌是美国癌症死亡的第五大主要原因。新辅助放化疗已在多项试验中作为一种将局部晚期疾病降期至可切除性的策略进行了研究。本研究的目的是在一个基于人群的大样本组中，检验新辅助放射治疗（RT）与其他治疗方法对可切除胰腺癌患者长期生存的影响。
查询监测、流行病学和最终结果（SEER）登记数据库（1994 - 2003年）中手术切除的胰腺癌病例。进行回顾性分析。研究的终点是总生存期。
使用Kaplan - Meier分析，我们发现接受新辅助RT的患者中位总生存期为23个月，未接受RT的患者为12个月，接受辅助RT的患者为17个月。使用Cox回归并控制独立协变量（年龄、性别、分期、分级和诊断年份），我们发现新辅助RT导致的生存率显著高于其他治疗方法（风险比[HR]，0.55；95%置信区间，0.38 - 0.79；p = 0.001）。具体比较辅助RT与新辅助RT，我们发现接受新辅助RT而非辅助RT的患者死亡风险比显著更低（HR，0.63；95%置信区间，0.45 - 0.90；p = 0.03）。
对SEER数据的这项分析表明，在治疗胰腺癌方面，使用新辅助RT比单纯手术或手术加辅助RT有生存获益。对于可切除胰腺癌患者，应进一步探索使用新辅助RT的治疗策略。
