Lutfi Waseem, Talamonti Mark S, Kantor Olga, Wang Chi-Hsiung, Stocker Susan J, Bentrem David J, Roggin Kevin K, Winchester David J, Marsh Robert, Prinz Richard A, Baker Marshall S
Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.
Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States.
Am J Surg. 2017 Mar;213(3):521-525. doi: 10.1016/j.amjsurg.2016.11.039. Epub 2016 Nov 30.
Neoadjuvant protocols for early stage pancreatic adenocarcinoma (PDAC) frequently involve external beam radiation used in combination with systemic chemotherapy. The benefit of radiation in these protocols has not been determined.
We examined patients with stage I and II PDAC within the National Cancer Data Base between 2006 and 2012. Propensity score matching was used to compare patients receiving neoadjuvant chemotherapy including radiation (NCRT) to those receiving neoadjuvant chemotherapy without radiation (NCT) prior to pancreaticoduodenectomy.
Prior to matching, NCRT patients had higher rates of T3 tumors (P = 0.046) and vascular abutment (P < 0.001). Propensity score matching (1:1) yielded 397 patients per group. Patients treated with NCRT were more likely to have node negative resections (P < 0.001) but had increased rates of 90-day mortality (P = 0.015) and demonstrated a trend towards shorter overall survival (P = 0.0502) than those receiving NCT.
In early stage PDAC, the addition of radiation to NCT is often utilized with more advanced disease and is associated with higher perioperative mortality and no long-term overall survival benefit.
早期胰腺腺癌（PDAC）的新辅助治疗方案通常包括外照射放疗与全身化疗联合应用。这些方案中放疗的益处尚未确定。
我们研究了2006年至2012年美国国立癌症数据库中I期和II期PDAC患者。采用倾向评分匹配法，比较在胰十二指肠切除术前行新辅助化疗联合放疗（NCRT）的患者与行新辅助化疗但未放疗（NCT）的患者。
匹配前，NCRT组患者T3期肿瘤发生率（P = 0.046）和血管受累发生率（P < 0.001）更高。倾向评分匹配（1:1）后，每组有397例患者。接受NCRT治疗的患者更有可能进行淋巴结阴性切除（P < 0.001），但90天死亡率更高（P = 0.015），且总生存期有短于接受NCT患者的趋势（P = 0.0502）。
在早期PDAC中，NCT联合放疗常用于病情更晚期的患者，且与围手术期死亡率较高相关，并无长期总生存获益。
