分析放疗对可切除的 I/II 期胰腺癌患者生存的影响：一项基于人群的研究。
Analysis of radiotherapy impact on survival in resected stage I/II pancreatic cancer patients: a population-based study.
机构信息
Department of Oncology & Hematology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No.23 Back street in the Museum of Art Rd, Dongcheng District, Beijing, China.
Department of Oncology, LuanPing Hospital of Traditional Chinese Medicine, No.57, Baojian Road, Xinjian Street, Luanping Town, Chengde City, HeBei Province, China.
出版信息
BMC Cancer. 2021 May 17;21(1):560. doi: 10.1186/s12885-021-08288-4.
BACKGROUND
The application of radiotherapy (RT) in pancreatic cancer remains controversial.
AIM
The aim of the study was to evaluate the efficacy of radiotherapy (neoadjuvant and adjuvant radiotherapy) for resectable I/II pancreatic cancer.
METHODS
Fourteen thousand nine hundred seventy-seven patients with pancreatic cancer were identified from SEER database from 2004 to 2015. Multivariate analyses were performed to determine factors including RT on overall survival. Overall survival and overall mortality among the different groups were evaluated using the Kaplan-Meier method and Gray's test.
RESULTS
Patients were divided into groups according to whether they received radiotherapy or not. The median survival time of all 14,977 patients without RT was 20 months, neoadjuvant RT was 24 months and adjuvant RT was 23 months (p < 0.0001). Median survival time of 2089 stage I patients without RT was 56 months, significantly longer than those with RT regardless of neoadjuvant or adjuvant RT (no RT: 56 months vs adjuvant RT: 37 months vs neoadjuvant RT: 27 months, P = 0.0039). Median survival time of 12,888 stage II patients with neoadjuvant RT was 24 months, adjuvant RT 22 months, significantly prolonged than those without radiotherapy (neoadjuvant RT: 24 months vs adjuvant RT: 22 months vs no RT: 17 months, P<0.0001). Neoadjuvant RT (HR = 1.434, P = 0.023, 95% CI: 1.051-1.957) was independent risk factors for prognosis of stage I patients, and adjuvant RT (HR = 0.904, P < 0.001, 95% CI: 0.861-0.950) predicted better outcomes for prognosis of stage II patients by multivariate analysis. The risk of cancer-related death caused by neoadjuvant RT in stage I and no-RT in stage II patients were significantly higher.
CONCLUSIONS
The study identified a significant survival advantage for the use of adjuvant RT over surgery alone or neoadjuvant RT in treating stage II pancreatic cancer. RT was not associated with survival benifit in stage I patients.
背景
放射治疗（RT）在胰腺癌中的应用仍存在争议。
目的
本研究旨在评估可切除 I/II 期胰腺癌的新辅助和辅助放疗的疗效。
方法
从 2004 年至 2015 年，从 SEER 数据库中确定了 14977 例胰腺癌患者。采用多变量分析确定包括 RT 在内的总生存相关因素。使用 Kaplan-Meier 方法和 Gray 检验评估不同组之间的总生存和总死亡率。
结果
患者根据是否接受放疗分为两组。所有未接受 RT 的 14977 例患者的中位生存时间为 20 个月，新辅助 RT 为 24 个月，辅助 RT 为 23 个月（p<0.0001）。未接受 RT 的 2089 例 I 期患者的中位生存时间为 56 个月，明显长于接受任何新辅助或辅助 RT 的患者（无 RT：56 个月 vs 辅助 RT：37 个月 vs 新辅助 RT：27 个月，P=0.0039）。接受新辅助 RT 的 12888 例 II 期患者的中位生存时间为 24 个月，接受辅助 RT 的患者为 22 个月，明显长于未接受放疗的患者（新辅助 RT：24 个月 vs 辅助 RT：22 个月 vs 无 RT：17 个月，P<0.0001）。多变量分析显示，新辅助 RT（HR=1.434，P=0.023，95%CI：1.051-1.957）是 I 期患者预后的独立危险因素，而辅助 RT（HR=0.904，P<0.001，95%CI：0.861-0.950）预测 II 期患者预后更好。I 期患者新辅助 RT 和 II 期患者无 RT 导致癌症相关死亡的风险明显更高。
结论
本研究发现，与单独手术或新辅助 RT 相比，辅助 RT 治疗 II 期胰腺癌具有显著的生存优势。RT 对 I 期患者的生存获益无影响。
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