Department of Surgery, 12269University of Minnesota Medical School, Minneapolis, MN, USA.
Division of Surgical Oncology, Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA.
Cancer Control. 2022 Jan-Dec;29:10732748221109991. doi: 10.1177/10732748221109991.
It is unclear whether the addition of chemoradiation (CRT) to adjuvant chemotherapy (CT) following upfront resection of pancreatic ductal adenocarcinoma (PDAC) provides any benefit. While some studies have suggested a benefit to combined modality therapy (CMT) (adjuvant CT plus CRT), it is not clear if this benefit was related to increased CT usage in patients who received CMT. We sought to clarify the use of CMT in patients who underwent upfront resection of PDAC.
Patients with non-metastatic PDAC were retrospectively identified from the linked SEER-Medicare database. Those who underwent upfront resection were identified and divided into two cohorts - patients who received adjuvant CT and patients who received adjuvant CMT. Cohorts were compared. Univariate analysis described patient characteristics. Kaplan-Meier and multivariable Cox proportional hazards modeling were used to estimate overall survival (OS).
3555 patients were identified; 856 (24%) received CT and 573 (16%) received CMT. The median number of CT doses was 11 for both groups. Patients who received CMT were younger, diagnosed in the earlier time frame, and had fewer comorbidities. The median OS was 21 months and 18 months for those treated with CMT and CT ( < .0001), respectively, but when stratified by nodal status, the association with improved OS in the CMT cohort was only observed in node-positive patients. On multivariable analysis, receipt of CMT and removal of >15 lymph nodes decreased the risk of death ( < .05).
Receipt of CMT following upfront resection for PDAC was associated with improved survival, which was confined to node-positive patients. The role of adjuvant CMT in PDAC with nodal metastases warrants further study.
在胰导管腺癌（PDAC）根治性切除后，辅助化疗（CT）联合放化疗（CRT）是否有益尚不清楚。虽然一些研究表明联合治疗模式（CMT，辅助 CT 加 CRT）有益，但尚不清楚这种获益是否与接受 CMT 的患者 CT 使用增加有关。我们旨在阐明接受 PDAC 根治性切除术的患者中 CMT 的使用情况。
从链接的 SEER-Medicare 数据库中回顾性确定非转移性 PDAC 患者。识别出接受根治性切除术的患者，并将其分为两组 - 接受辅助 CT 治疗的患者和接受辅助 CMT 治疗的患者。对两组进行比较。单变量分析描述了患者特征。采用 Kaplan-Meier 和多变量 Cox 比例风险模型估计总生存期（OS）。
共确定 3555 例患者；856 例（24%）接受 CT 治疗，573 例（16%）接受 CMT 治疗。两组的中位 CT 剂量均为 11 次。接受 CMT 的患者年龄较小，诊断时间较早，合并症较少。CMT 组和 CT 组的中位 OS 分别为 21 个月和 18 个月（<0.0001），但按淋巴结状态分层时，CMT 组 OS 改善与仅观察到淋巴结阳性患者相关。多变量分析显示，接受 CMT 治疗和切除>15 个淋巴结可降低死亡风险（<0.05）。
在 PDAC 根治性切除后接受 CMT 治疗与生存改善相关，这种改善仅局限于淋巴结阳性患者。CMT 在伴有淋巴结转移的 PDAC 中的作用需要进一步研究。
