Yang Relin, Cheung Michael C, Byrne Margaret M, Jin Xiaoling, Montero Alberto J, Jones Catherine, Koniaris Leonidas G
DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL 33136, USA.
Arch Surg. 2010 Jan;145(1):49-56. doi: 10.1001/archsurg.2009.244.
The survival benefit of adjuvant chemotherapy alone or chemoradiotherapy in patients with pancreatic cancer who have undergone surgical resection remains unclear.
To identify the additional benefit of adjuvant therapy by retrospectively examining a large population-based registry of patients who underwent definitive surgical resection for pancreatic adenocarcinoma.
The Florida cancer registry and state inpatient and outpatient hospital data records were queried for pancreatic adenocarcinoma diagnosed between 1998 and 2002.
A total of 2877 patients who underwent surgical resection with curative intent for pancreatic adenocarcinoma were identified. Main Outcome Measure Overall survival time.
Overall, 58.7% of patients were older than 65 years. Most patients were white (90.7%), were non-Hispanic (86.7%), and did not consume alcohol abusively (89.2%). Approximately half of the patients (51.9%) did not receive chemotherapy or chemoradiotherapy. Approximately 25.0% of the patients underwent chemoradiotherapy, and 10.0% received chemotherapy alone. Patients were more frequently treated at low-volume centers (57.6%) and nonteaching facilities (72.8%). Multivariate analysis correcting for patient comorbidities demonstrated that postoperative chemoradiotherapy (hazard ratio = 0.69, P = .04) and treatment at high-volume centers (hazard ratio = 0.85, P < .001) and teaching facilities (hazard ratio = 0.84, P < .001) were independent predictors of improved survival.
Adjuvant chemoradiotherapy was found to provide a significant additional survival benefit to surgical resection for patients with pancreatic adenocarcinoma. Furthermore, this benefit is independent of the additional survival advantage when patients are treated at teaching facilities or high-volume centers. Although selection bias may be contributing to the observed differences, these data nonetheless support the use of adjuvant chemoradiotherapy for pancreatic cancer.
对于接受手术切除的胰腺癌患者，单纯辅助化疗或放化疗的生存获益仍不明确。
通过回顾性研究一个基于人群的大型胰腺癌根治性手术切除患者登记系统，确定辅助治疗的额外获益。
查询佛罗里达癌症登记处以及该州住院和门诊医院数据记录，以获取1998年至2002年期间诊断为胰腺腺癌的患者信息。
共识别出2877例接受了胰腺癌根治性手术切除的患者。主要观察指标为总生存时间。
总体而言，58.7%的患者年龄超过65岁。大多数患者为白人（90.7%）、非西班牙裔（86.7%）且无酗酒习惯（89.2%）。约一半患者（51.9%）未接受化疗或放化疗。约25.0%的患者接受了放化疗，10.0%的患者仅接受了化疗。患者更多地在低手术量中心（57.6%）和非教学机构（72.8%）接受治疗。校正患者合并症的多因素分析表明，术后放化疗（风险比=0.69，P = 0.04）、在高手术量中心治疗（风险比=0.85，P < 0.001）以及在教学机构治疗（风险比=0.84，P < 0.001）是生存改善的独立预测因素。
发现辅助放化疗可为胰腺腺癌患者的手术切除带来显著的额外生存获益。此外，当患者在教学机构或高手术量中心接受治疗时，这种获益独立于额外的生存优势。尽管选择偏倚可能导致了观察到的差异，但这些数据仍支持对胰腺癌使用辅助放化疗。
