Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Cancer. 2010 Jul 1;116(13):3257-66. doi: 10.1002/cncr.25069.
The benefit of adjuvant radiotherapy (RT) for resected pancreatic adenocarcinoma remains controversial after randomized clinical trials. In this national-level US study, a propensity score (conditional probability of receiving RT) was used to adjust for potential confounding in nonrandomized designs from treatment group differences.
Patients were identified from the Surveillance, Epidemiology, and End Results (SEER) registry (1988-2005 dataset). Multivariate analyses to determine the effect of RT on overall survival were performed using propensity-adjusted Cox proportional hazards and Kaplan-Meier analyses.
In total, 5676 patients with resected pancreatic adenocarcinoma were identified, and 40.8% of those patients had received adjuvant RT. Univariate predictors of survival included age, race, marital status, disease stage, tumor size, tumor extension, tumor grade, lymph node status, year of diagnosis, type of resection, and receipt of RT (all P < .002). In a Cox model, independent predictors of improved survival included white race, married status, earlier stage, smaller tumors, well differentiated tumors, negative lymph node (N0) status, recent diagnosis, and receipt of RT (all P < .05). In a propensity-adjusted proportional hazards regression, the benefit of adjuvant treatment that included RT remained significant after adjusting for the likelihood of receiving RT (hazard ratio, 0.773; 95% confidence interval, 0.714-0.836; P < .0001). Within all 5 propensity strata, Kaplan-Meier survival differed significantly (P < .0001 [lowest and highest probability strata] and P = .0165 [middle stratum with a "pseudorandom" probability of RT]).
Adjuvant RT for resected pancreatic adenocarcinoma was associated with a significant survival advantage in a large national database, even after using propensity score methods to adjust for differences between treatment groups. The authors concluded that adjuvant RT should be considered for all appropriate patients who have resected pancreatic adenocarcinoma.
在随机临床试验之后，辅助放疗（RT）对切除的胰腺腺癌的益处仍存在争议。在这项美国全国性研究中，使用倾向评分（接受 RT 的条件概率）来调整非随机设计中治疗组差异引起的潜在混杂因素。
从监测、流行病学和最终结果（SEER）登记处（1988-2005 年数据集）中确定患者。使用倾向评分调整的 Cox 比例风险和 Kaplan-Meier 分析进行多变量分析，以确定 RT 对总生存的影响。
总共确定了 5676 例切除的胰腺腺癌患者，其中 40.8%的患者接受了辅助 RT。生存的单变量预测因素包括年龄、种族、婚姻状况、疾病分期、肿瘤大小、肿瘤扩展、肿瘤分级、淋巴结状态、诊断年份、手术类型和 RT 治疗（均 P <.002）。在 Cox 模型中，独立的生存改善预测因素包括白种人、已婚、早期分期、较小的肿瘤、分化良好的肿瘤、阴性淋巴结（N0）状态、近期诊断和 RT 治疗（均 P <.05）。在倾向评分调整的比例风险回归中，在调整接受 RT 的可能性后，辅助治疗（包括 RT）的益处仍然显著（危险比，0.773；95%置信区间，0.714-0.836；P <.0001）。在所有 5 个倾向评分分层中，Kaplan-Meier 生存差异均有统计学意义（P <.0001[最低和最高概率分层]和 P =.0165[中间分层，RT 的“伪随机”概率]）。
在一个大型国家数据库中，即使使用倾向评分方法调整治疗组之间的差异，切除的胰腺腺癌的辅助 RT 与显著的生存优势相关。作者得出结论，辅助 RT 应考虑用于所有有切除的胰腺腺癌的合适患者。
