Wang Dan, Ge Heming, Tian Mengxiang, Li Chenglong, Zhao Lilan, Pei Qian, Tan Fengbo, Li Yuqiang, Ling Chen, Güngör Cenap
Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Front Oncol. 2022 Jan 31;12:799930. doi: 10.3389/fonc.2022.799930. eCollection 2022.
It remains controversial whether radiotherapy (RT) improves survival in patients with stage IIB/III PDAC. A growing number of studies have found that patients' age at diagnosis and tumor site not only affect prognosis, but also may lead to different treatment responses. Therefore, the purpose of this study was to verify whether the survival effect of radiotherapy in patients with stage IIB/III PDAC varies across age and tumor site groups.
The target population was selected from PDAC patients undergone surgery in the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2016. This study performed the Pearson's chi-square test, Cox regression analysis, Kaplan-Meier (K-M) method, and focused on propensity frequency matching analysis.
Neither neoadjuvant radiotherapy (nRT) nor adjuvant radiotherapy (aRT) patient group had probably improved survival among early-onset patients. For middle-aged patients, nRT seemed to fail to extend overall survival (OS), while aRT might improve the OS. Plus, both nRT and aRT were associated with improved survival in elderly patients. The aRT might be related with survival benefits in patients with pancreatic head cancer, while nRT was not. And RT in patients with PDAC at other sites did not appear to provide a survival benefit.
Carefully selected data from the SEER database suggested that age and tumor location may be the reference factors to guide the selection of RT for patients with stage IIB/III PDAC. These findings are likely to contribute to the development of personalized treatment for patients with stage IIB/III PDAC.
对于IIB/III期胰腺导管腺癌（PDAC）患者，放疗（RT）是否能提高生存率仍存在争议。越来越多的研究发现，患者的诊断年龄和肿瘤部位不仅影响预后，还可能导致不同的治疗反应。因此，本研究的目的是验证IIB/III期PDAC患者放疗的生存效果在不同年龄和肿瘤部位组中是否存在差异。
目标人群选自2004年至2016年监测、流行病学和最终结果（SEER）数据库中接受手术的PDAC患者。本研究进行了Pearson卡方检验、Cox回归分析、Kaplan-Meier（K-M）方法，并重点进行了倾向频率匹配分析。
新辅助放疗（nRT）组和辅助放疗（aRT）组在早发患者中均未显著提高生存率。对于中年患者，nRT似乎未能延长总生存期（OS），而aRT可能会改善OS。此外，nRT和aRT均与老年患者生存率提高相关。aRT可能与胰头癌患者的生存获益有关，而nRT则不然。PDAC位于其他部位的患者接受放疗似乎未带来生存获益。
从SEER数据库中精心挑选的数据表明，年龄和肿瘤位置可能是指导IIB/III期PDAC患者放疗选择的参考因素。这些发现可能有助于IIB/III期PDAC患者个性化治疗方案的制定。
