Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK.
Department of Surgery, University of Michigan, Ann Arbor, MI.
Ann Surg. 2021 Mar 1;273(3):587-594. doi: 10.1097/SLA.0000000000003242.
There is conflicting evidence for the benefit of adjuvant radiotherapy (RT) after resection of pancreatic ductal adenocarcinoma (PDAC), especially for margin-negative (R0) resections. We aimed to evaluate the association of adjuvant RT with survival after R0 resection of PDAC.
Using National Cancer Database (NCDB) data from 2004 to 2013, we identified patients with R0 resection of nonmetastatic PDAC. Patients with neoadjuvant radiotherapy and chemotherapy and survival <6 months were excluded. Propensity score matching was used to account for treatment selection bias. A multivariable Cox proportional hazards model was then used to analyze the association of RT with survival.
Of 4547 (36%) RT and 7925 (64%) non-RT patients, 3860 RT and 3860 non-RT patients remained in the cohort after matching. Clinicopathologic and demographic variables were well balanced after matching. Lymph node metastases were present in 68% (44% N1, 24% N2). After matching, RT was associated with higher survival (median 25.8 vs 23.9 mo, 5-yr 27% vs 24%, P < 0.001). After multivariable adjustment, RT remained associated with a survival benefit (HR 0.89, 95% CI 0.84-0.94, P < 0.001). Stratified and multivariable interaction analyses showed that this benefit was restricted to patients with node-positive disease: N1 (HR: 0.68, CI95%: 0.62-0.76, P = 0.007) and N2 (HR: 0.59, CI95%: 0.54-0.64, P = 0.04).
In this large retrospective cohort study, adjuvant RT after R0 PDAC resection was associated with a survival benefit in patients with node-positive disease. Adjuvant RT should be considered after R0 resection of PDAC with node-positive disease.
辅助放疗（RT）对胰腺导管腺癌（PDAC）切除术后的益处存在争议，尤其是对于切缘阴性（R0）的切除。我们旨在评估 R0 切除 PDAC 后辅助 RT 与生存的关系。
利用 2004 年至 2013 年国家癌症数据库（NCDB）的数据，我们确定了 R0 切除非转移性 PDAC 的患者。排除了接受新辅助放化疗和生存时间<6 个月的患者。采用倾向评分匹配来解释治疗选择偏倚。然后，采用多变量 Cox 比例风险模型分析 RT 与生存的关系。
在 4547 例（36%）接受 RT 和 7925 例（64%）未接受 RT 的患者中，在匹配后，3860 例接受 RT 和 3860 例未接受 RT 的患者留在队列中。匹配后，临床病理和人口统计学变量得到很好的平衡。淋巴结转移占 68%（44% N1，24% N2）。匹配后，RT 与生存获益相关（中位 25.8 与 23.9 个月，5 年生存率为 27%与 24%，P<0.001）。经过多变量调整，RT 仍与生存获益相关（HR 0.89，95%CI 0.84-0.94，P<0.001）。分层和多变量交互分析表明，这种获益仅限于淋巴结阳性疾病患者：N1（HR：0.68，95%CI95%：0.62-0.76，P=0.007）和 N2（HR：0.59，95%CI95%：0.54-0.64，P=0.04）。
在这项大型回顾性队列研究中，R0 切除 PDAC 后辅助 RT 与淋巴结阳性疾病患者的生存获益相关。对于淋巴结阳性的 PDAC，在 R0 切除术后应考虑辅助 RT。
