Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
Cancer. 2014 Apr 15;120(8):1171-7. doi: 10.1002/cncr.28543. Epub 2014 Jan 3.
The objective of this study was to determine the effects of postoperative radiation therapy (PORT) and lymph node dissection (LND) on survival in patients with pancreatic cancer.
The 2004 to 2008 Surveillance, Epidemiology, and End Results (SEER) database was analyzed to identify patients with pancreatic cancer who underwent surgery and received chemotherapy and to evaluate the correlation between overall survival (OS), PORT, and LND.
In total, 2966 patients were identified who underwent pancreatic resection (1842 PORT, 1124 no PORT). Median survival, 1-year OS, and 3-year OS were 21 months, 77%, and 28%, respectively, with PORT versus 20 months, 70%, and 25%, respectively, without PORT (P = .02). Subset analysis revealed that the benefit of PORT was limited to lymph node-positive (N1) patients. Median survival, 1-year OS, and 3-year OS for patients with N1 disease were 19 months, 73%, and 25%, respectively, for those who received PORT versus 18 months, 67%, and 20%, respectively, for those who did not receive PORT (P < .01). An increasing lymph node count was associated with increased survival on multivariate analysis in all patients and in patients with N1 disease (both P < .001). Significant cutoff points for OS based on LND in patients with N1 disease were identified for those who had ≥8, ≥10, ≥12, ≥15, and ≥20 lymph nodes resected. Multivariate analysis for OS revealed that increasing age, T3 and T4 tumors, N1 stage, and moderately and poorly differentiated grade were prognostic for increased mortality, while female gender, PORT, and LND were prognostic for decreased mortality. In patients with N1 disease, other than patient age, all of these factors remained significant. In patients with N0 disease, only T1 and T2 tumor classification and having a tumor that was less than high grade were associated with survival benefit.
This SEER analysis demonstrated an associated survival benefit of PORT and LND in patients with N1, surgically resected pancreatic cancer who received chemotherapy.
本研究旨在确定术后放疗（PORT）和淋巴结清扫术（LND）对胰腺癌患者生存的影响。
对 2004 年至 2008 年监测、流行病学和最终结果（SEER）数据库进行分析，以确定接受手术和化疗的胰腺癌患者，并评估总体生存率（OS）、PORT 和 LND 之间的相关性。
共确定了 2966 例接受胰腺切除术的患者（1842 例 PORT，1124 例无 PORT）。PORT 组的中位生存期、1 年 OS 和 3 年 OS 分别为 21 个月、77%和 28%，无 PORT 组分别为 20 个月、70%和 25%（P=0.02）。亚组分析显示，PORT 的获益仅限于淋巴结阳性（N1）患者。N1 疾病患者 PORT 组的中位生存期、1 年 OS 和 3 年 OS 分别为 19 个月、73%和 25%，无 PORT 组分别为 18 个月、67%和 20%（P＜0.01）。多变量分析显示，在所有患者和 N1 疾病患者中，淋巴结计数的增加与生存时间的延长相关（均 P＜0.001）。在 N1 疾病患者中，基于 LND 的 OS 有显著的截点，即切除的淋巴结≥8、≥10、≥12、≥15 和≥20 个。多变量分析显示，年龄增长、T3 和 T4 肿瘤、N1 期以及中、低分化程度与死亡率增加相关，而女性、PORT 和 LND 与死亡率降低相关。在 N1 疾病患者中，除患者年龄外，所有这些因素仍然具有显著性。在 N0 疾病患者中，只有 T1 和 T2 肿瘤分类和肿瘤分级较低与生存获益相关。
这项 SEER 分析表明，在接受化疗的 N1 期可切除胰腺癌患者中，PORT 和 LND 与生存获益相关。
