术前放疗可改善手术切除后 pT4 胰腺导管腺癌患者的总生存率。

Preoperative radiotherapy improves overall survival of pT4 pancreatic ductal adenocarcinoma patients after surgical resection.

机构信息

Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai, China.

出版信息

Jpn J Clin Oncol. 2020 Jun 10;50(6):679-687. doi: 10.1093/jjco/hyaa035.

DOI:10.1093/jjco/hyaa035

PMID:32372083

Abstract

OBJECTIVE

The aim of delivering radiotherapy for pancreatic ductal adenocarcinoma patients was to sterilize vessel margin, increase R0 resection rate and delay local progression. Whether preoperative radiotherapy could prolong overall survival of surgical candidates remained unknown.

METHODS

Pancreatic ductal adenocarcinoma patients receiving radical resection from surveillance, epidemiology and end result database were enrolled. Propensity score matching was conducted to balance difference in baseline characteristics, and survival analyses were performed to compare overall survival between preoperative radiotherapy and upfront resection groups. Cox proportional hazard regression model and subgroup analyses were utilized to identify prognostic factors.

RESULTS

A total of 11 665 and 597 pancreatic ductal adenocarcinoma patients receiving upfront resection and preoperative radiotherapy followed by resection from 2004 to 2016 were identified, respectively, while baseline characteristics were distinct between groups. After propensity score matching, preoperative radiotherapy was not associated with better overall survival (upfront resection vs preoperative radiotherapy, 26 vs 27 months). Subgroup analyses showed that preoperative radiotherapy was a protective factor in pT4 (hazard ratio = 0.64, 95% confidence interval: 0.47-0.88) but a negative predictor in pT1 (hazard ratio = 1.79, 95% confidence interval: 1.08-2.97) patient populations. Survival analyses showed that preoperative radiotherapy improved overall survival of patients with pT4 stage (upfront resection vs preoperative radiotherapy, 19 vs 25 months) and involvement of celiac axis, superior mesenteric artery and aorta (upfront resection vs preoperative radiotherapy, 20 vs 27 months), while preoperative radiotherapy was associated with worse overall survival in patients with pT1 tumor (upfront resection vs preoperative radiotherapy, 39 vs 24 months).

CONCLUSION

Preoperative radiotherapy could improve survival of resected pancreatic ductal adenocarcinoma patients with pT4 stage or with celiac axis, superior mesenteric artery and aorta invasion.

摘要

目的

为胰腺导管腺癌患者提供放疗的目的是消灭血管边缘，提高 R0 切除率并延缓局部进展。术前放疗是否能延长手术候选者的总生存期仍不清楚。

方法

从监测、流行病学和最终结果数据库中招募接受根治性切除术的胰腺导管腺癌患者。采用倾向评分匹配来平衡基线特征的差异，并对术前放疗组和 upfront 切除术组的总生存期进行生存分析。利用 Cox 比例风险回归模型和亚组分析来确定预后因素。

结果

分别从 2004 年至 2016 年确定了 11665 例和 597 例接受 upfront 切除术和术前放疗后再切除术的胰腺导管腺癌患者，两组的基线特征存在明显差异。经过倾向评分匹配后，术前放疗与更好的总生存期无关（ upfront 切除术 vs 术前放疗，26 个月 vs 27 个月）。亚组分析表明，术前放疗是 pT4 患者的保护因素（危险比=0.64，95%置信区间：0.47-0.88），但在 pT1 患者中是负面预测因素（危险比=1.79，95%置信区间：1.08-2.97）。生存分析表明，术前放疗改善了 pT4 期（ upfront 切除术 vs 术前放疗，19 个月 vs 25 个月）和腹腔动脉、肠系膜上动脉和主动脉受累（ upfront 切除术 vs 术前放疗，20 个月 vs 27 个月）患者的总生存期，而术前放疗与 pT1 肿瘤患者的总生存期较差相关（ upfront 切除术 vs 术前放疗，39 个月 vs 24 个月）。