de Geus Susanna W L, Bliss Lindsay A, Eskander Mariam F, Ng Sing Chau, Vahrmeijer Alexander L, Mahadevan Anand, Kent Tara S, Moser A James, Callery Mark P, Bonsing Bert A, Tseng Jennifer F
Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Department of Surgery, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands.
J Gastrointest Surg. 2016 Jan;20(1):85-92; discussion 92. doi: 10.1007/s11605-015-2951-8. Epub 2015 Oct 1.
Adjuvant chemotherapy plays a critical role in the treatment of resected pancreatic cancer patients. However, the role of adjuvant radiation remains controversial. This study compares survival between resected pancreatic cancer patients who received adjuvant radiation and no adjuvant radiation. Medical records of patients with pancreatic ductal adenocarcinoma who underwent surgical resection from January 2003 through 2013 at medical centers in Boston and Leiden were retrospectively reviewed. Propensity score matching was used to correct for potential selection bias in the allocation of adjuvant chemoradiation versus chemotherapy alone. Three hundred fifty total patients were identified, of whom 138 (39.4%) received adjuvant radiation. On pathological staging, 245 (70.0%) had positive lymph nodes, and these patients gained a significant survival benefit from adjuvant radiation (hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.56-0.99) in the complete cohort. After propensity score matching, adjuvant radiation lost its prognostic significance in the complete cohort. However, after matching, patients who survived longer than 12 months and had positive lymph nodes (n = 108) demonstrated a significant (log-rank p = 0.04) survival benefit from adjuvant radiation. This study, while non-randomized, suggests that adjuvant radiation may be associated with a survival benefit for resected pancreatic cancer patients in specific situations.
辅助化疗在可切除胰腺癌患者的治疗中起着关键作用。然而，辅助放疗的作用仍存在争议。本研究比较了接受辅助放疗和未接受辅助放疗的可切除胰腺癌患者的生存率。对2003年1月至2013年期间在波士顿和莱顿的医疗中心接受手术切除的胰腺导管腺癌患者的病历进行了回顾性分析。倾向评分匹配用于纠正辅助放化疗与单纯化疗分配中潜在的选择偏倚。共确定了350例患者，其中138例（39.4%）接受了辅助放疗。在病理分期方面，245例（70.0%）有淋巴结转移，在整个队列中，这些患者从辅助放疗中获得了显著的生存获益（风险比（HR）0.74；95%置信区间（CI）0.56 - 0.99）。倾向评分匹配后，辅助放疗在整个队列中失去了预后意义。然而，匹配后，生存超过12个月且有淋巴结转移的患者（n = 108）从辅助放疗中显示出显著的（对数秩检验p = 0.04）生存获益。本研究虽非随机研究，但表明在特定情况下，辅助放疗可能与可切除胰腺癌患者的生存获益相关。
