Moody John S, Sawrie Stephen M, Kozak Kevin R, Plastaras John P, Howard George, Bonner James A
Department of Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35294-3300, USA.
J Gastroenterol. 2009;44(1):84-91. doi: 10.1007/s00535-008-2280-8. Epub 2009 Jan 22.
The role of adjuvant radiotherapy (RT) for pancreatic cancer remains controversial despite the completion of three multi-institutional randomized trials. This study examines the survival impact of postoperative RT in a large population-based database.
Patients with pancreatic cancer diagnosed from 1988 to 2003 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The cohort was limited to patients who underwent resection of nonmetastatic disease to yield a population of 3252 patients. The primary end point was overall survival. Survival analyses were conducted using corrections for perioperative mortality as well as a propensity score analysis to account for baseline differences in patient characteristics.
Multiple independent factors were associated with RT use, including patient age and disease stage (P < 0.0001). In general, younger patients and those with more advanced disease were more likely to receive RT. Disease stage significantly affected survival (P < 0.0001). For patients who survived at least 6 months, adjuvant RT was associated with increased survival [hazard ratio (HR), 0.87; 95% confidence interval (CI), 0.80-0.96]. On subgroup analysis, only stage IIB (T1-3N1) patients enjoyed a statistically significant benefit associated with RT (HR, 0.70; 95% CI, 0.62-0.79).
Adjuvant RT is frequently given to patients in the United States after resection of their pancreatic cancer. Although RT is associated with a survival benefit for nonmetastatic patients as a whole, this trend appears to predominantly derive from a survival benefit in patients with stage IIB disease.
尽管三项多机构随机试验已经完成，但辅助放疗（RT）在胰腺癌治疗中的作用仍存在争议。本研究在一个基于人群的大型数据库中探讨了术后放疗对生存的影响。
在监测、流行病学和最终结果（SEER）数据库中识别出1988年至2003年诊断为胰腺癌的患者。该队列仅限于接受非转移性疾病切除术的患者，最终得到3252例患者。主要终点是总生存期。生存分析采用围手术期死亡率校正以及倾向评分分析，以考虑患者特征的基线差异。
多个独立因素与放疗的使用相关，包括患者年龄和疾病分期（P < 0.0001）。一般来说，年轻患者和疾病进展较严重的患者更有可能接受放疗。疾病分期显著影响生存（P < 0.0001）。对于至少存活6个月的患者，辅助放疗与生存率提高相关[风险比（HR），0.87；95%置信区间（CI），0.80 - 0.96]。亚组分析显示，只有IIB期（T1 - 3N1）患者从放疗中获得了具有统计学意义的生存获益（HR，0.70；95% CI，0.62 - 0.79）。
在美国，胰腺癌切除术后患者经常接受辅助放疗。虽然放疗对非转移性患者总体生存有益，但这种趋势似乎主要源于IIB期疾病患者的生存获益。
