Department of Radiation Oncology and Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2010 Dec;17(12):3112-9. doi: 10.1245/s10434-010-1200-3. Epub 2010 Aug 3.
This study was designed to examine the effect of adjuvant 5-FU-based chemoradiation therapy (CRT) after distal pancreatectomy for adenocarcinoma of the distal pancreas.
All patients underwent curative resection for adenocarcinoma of the distal pancreas between December 1985 and June 2006. Patients who received adjuvant CRT were compared with those who underwent surgery alone. A Kaplan-Meier estimate of the survival curve was used to determine estimates of the median survival and proportion alive at 1 and 2 years; log-rank tests were used to make comparisons between groups.
A total of 123 patients underwent distal pancreatectomy; 29 patients were excluded for distant metastases at the time of surgery (n = 12, 10%) or before adjuvant therapy (n = 11, 9%), death within 2 months of surgery (n = 2, 2%), or if CRT treatment status was unknown (n = 4, 3%). Of the remaining 94 patients, 72% received adjuvant 5-FU-based CRT and 28% underwent surgery alone. Overall median survival was 16.2 (95% confidence interval (CI), 13.1-18.9) months. The groups were similar with respect to tumor size, nodal status, and margin status. There was no significant difference in overall survival between patients treated with adjuvant CRT versus surgery alone (p = 0.23). An exploratory subgroup analysis suggested a potential survival benefit of adjuvant CRT in patients with lymph node metastases (16.7 vs. 12.1 months, p < 0.01).
Adjuvant CRT did not increase survival compared with surgery alone; however, patients with node-positive disease appear to benefit from adjuvant CRT.
本研究旨在探讨辅助 5-FU 为基础的放化疗（CRT）对远端胰腺腺癌患者行远端胰腺切除术的疗效。
所有患者于 1985 年 12 月至 2006 年 6 月期间因远端胰腺腺癌接受根治性切除术。比较接受辅助 CRT 与单纯手术的患者。采用 Kaplan-Meier 估计生存曲线来确定中位生存时间和 1 年及 2 年生存率的估计值；对数秩检验用于组间比较。
共有 123 例患者行远端胰腺切除术；29 例因远处转移（n=12，10%）或术前（n=11，9%）、术后 2 个月内死亡（n=2，2%）或 CRT 治疗情况不详（n=4，3%）而被排除。在剩余的 94 例患者中，72%接受了辅助 5-FU 为基础的 CRT，28%接受了单纯手术。总体中位生存时间为 16.2（95%置信区间（CI），13.1-18.9）个月。两组在肿瘤大小、淋巴结状态和切缘状态方面相似。接受辅助 CRT 与单纯手术的患者总生存率无显著差异（p=0.23）。探索性亚组分析提示辅助 CRT 对淋巴结转移患者有潜在的生存获益（16.7 与 12.1 个月，p<0.01）。
与单纯手术相比，辅助 CRT 并未提高生存；然而，淋巴结阳性疾病患者似乎从辅助 CRT 中获益。
