Ecker Brett L, McMillan Matthew T, Datta Jashodeep, Lee Major K, Karakousis Giorgos C, Vollmer Charles M, Drebin Jeffrey A, Fraker Douglas L, Roses Robert E
Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Cancer. 2017 May 15;123(6):967-976. doi: 10.1002/cncr.30439. Epub 2016 Nov 7.
To the authors' knowledge, optimal adjuvant approaches for resected duodenal adenocarcinoma are not well established. Given the significant risk of locoregional disease recurrence, there may be a subset of patients who demonstrate an improvement in overall survival (OS) from the addition of radiotherapy (chemoradiotherapy [CRT]) to an adjuvant chemotherapy regimen.
Patients with resected, nonmetastatic duodenal adenocarcinoma who received chemotherapy (694 patients) or CRT (550 patients) were identified in the National Cancer Data Base (1998-2012). Cox regression identified covariates associated with OS. The chemotherapy and CRT cohorts were matched (1:1) by propensity scores based on the likelihood of receiving CRT or the survival hazard from Cox modeling. OS was compared using Kaplan-Meier estimates.
CRT was more frequently used for patients who underwent positive-margin surgical resection (15.9% vs 9.1%; P<.001). At a median follow-up of 79.2 months (interquartile range, 52.9-114.9 months), the median OS of the propensity score-matched cohort was 46.7 months (interquartile range, 18.9 months to not reached). No survival advantage was observed for patients who were treated with adjuvant CRT compared with those treated with adjuvant chemotherapy (median OS: 48.9 months vs 43.5 months [HR, 1.04; 95% confidence interval, 0.88-1.22 (P = .669)]). CRT was not found to be associated with a significant improvement in the median OS after positive-margin surgical resection (133 patients; 27.6 months vs 18.5 months [P = .210]) or in the presence of T4 classification (461 patients; 30.6 months vs 30.4 months [P = .844]) inadequate lymph node staging (584 patients; 40.5 months vs 43.2 months [P = .707]), lymph node positivity (647 patients; 38.3 months vs 34.1 months [P = .622]), or poorly differentiated histology (429 patients; 46.6 months vs 35.7 months [P = .434]).
The addition of radiation to adjuvant therapy does not appear to significantly improve survival, even in high-risk cases. Cancer 2017;123:967-76. © 2016 American Cancer Society.
据作者所知，对于已切除的十二指肠腺癌，最佳辅助治疗方法尚未完全确立。鉴于局部区域疾病复发风险较高，可能有一部分患者通过在辅助化疗方案中加入放疗（放化疗[CRT]）可改善总生存期（OS）。
在国家癌症数据库（1998 - 2012年）中识别出接受化疗（694例患者）或CRT（550例患者）的已切除、非转移性十二指肠腺癌患者。Cox回归分析确定与OS相关的协变量。根据接受CRT的可能性或Cox模型得出的生存风险，通过倾向评分将化疗组和CRT组进行1:1匹配。使用Kaplan - Meier估计值比较OS。
CRT更常用于切缘阳性手术切除的患者（15.9%对9.1%；P <.001）。在中位随访79.2个月（四分位间距，52.9 - 114.9个月）时，倾向评分匹配队列的中位OS为46.7个月（四分位间距，18.9个月至未达到）。与接受辅助化疗的患者相比，接受辅助CRT治疗的患者未观察到生存优势（中位OS：48.9个月对43.5个月[风险比，1.04；95%置信区间，0.88 - 1.22（P = 0.669）]）。未发现CRT与切缘阳性手术切除后（133例患者；27.6个月对18.5个月[P = 0.210]）、T4分期（461例患者；30.6个月对30.4个月[P = 0.844]）、淋巴结分期不足（584例患者；40.5个月对43.2个月[P = 0.707]）、淋巴结阳性（647例患者；38.3个月对34.1个月[P = 0.622]）或组织学分化差（429例患者；46.6个月对35.7个月[P = 0.434]）患者的中位OS显著改善相关。
即使在高危病例中，辅助治疗中加入放疗似乎也不能显著提高生存率。《癌症》2017年；123:967 - 76。©2016美国癌症协会
