Cao Bi-Yang, Zhang Le-Tian, Wu Chen-Chen, Wang Jing, Yang Lin
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
Front Oncol. 2024 Sep 16;14:1473251. doi: 10.3389/fonc.2024.1473251. eCollection 2024.
Chemotherapy (CT) remains the primary treatment for locally advanced unresectable pancreatic cancer (LAUPC) and metastatic pancreatic cancer (MPC). The role of radiotherapy (RT) in these conditions remains unclear. This study compares the outcomes of CT alone versus CT combined with RT (combined-modality therapy [CMT]) in LAUPC and MPC patients.
We conducted a retrospective analysis of LAUPC and MPC patients treated with either CT or CMT from a single institution and Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier curves and Cox hazards models evaluated the association between treatment modalities and overall survival (OS). Propensity score matching (PSM) ensured balanced comparisons. Landmark analysis addressed immortal time bias. Subgroup analyses were based on clinical characteristics. eXtreme Gradient Boosting (XGBoost) and Shapley Additive Explanations (SHAP) assessed outcome prediction and influence of significant predictors.
The study included 102 patients receiving CMT and 155 receiving CT at single institution, along with 1733 CMT and 9310 CT patients from the SEER dataset. In the single-institution cohort, CMT showed superior survival compared to CT both before (median OS: 20.5 vs. 11.5 months, hazard ratio [HR]: 0.47, 95% CI: 0.34-0.65, P=0.001) and after PSM (median OS: 22.2 vs. 11.8 months, HR: 0.49, 95% CI: 0.30-0.79, P=0.003). Multivariate analyses confirmed that CMT was independently associated with improved OS both before (HR: 0.54, 95% CI: 0.38-0.77, P=0.001) and after PSM (HR: 0.45, 95% CI: 0.27-0.73, P=0.001). Landmark analysis indicated better OS for patients receiving CMT compared to CT alone. Subgroup analysis revealed an OS benefit for CMT across most subgroups. SHAP value analysis indicated that CMT was the most significant contributor to survival outcomes. SEER database validation confirmed these findings.
This study demonstrates that CMT significantly improves OS in LAUPC and MPC patients compared to CT alone. Integrating RT with CT could be beneficial for treating LAUPC and MPC.
化疗（CT）仍然是局部晚期不可切除胰腺癌（LAUPC）和转移性胰腺癌（MPC）的主要治疗方法。放疗（RT）在这些情况下的作用仍不明确。本研究比较了LAUPC和MPC患者单纯CT与CT联合RT（综合治疗[CMT]）的疗效。
我们对来自单一机构以及监测、流行病学和最终结果（SEER）数据库中接受CT或CMT治疗的LAUPC和MPC患者进行了回顾性分析。Kaplan-Meier曲线和Cox风险模型评估了治疗方式与总生存期（OS）之间的关联。倾向评分匹配（PSM）确保了均衡的比较。地标性分析解决了不朽时间偏倚问题。亚组分析基于临床特征。极端梯度提升（XGBoost）和Shapley加性解释（SHAP）评估了结果预测以及显著预测因素的影响。
该研究纳入了单一机构中102例接受CMT的患者和155例接受CT的患者，以及SEER数据集中1733例CMT患者和9310例CT患者。在单一机构队列中，CMT在PSM之前（中位OS：20.5个月对11.5个月，风险比[HR]：0.47，95%CI：0.34 - 0.65，P = 0.001）和之后（中位OS：22.2个月对11.8个月，HR：0.49，95%CI：0.30 - 0.79，P = 0.003）均显示出比CT更好的生存率。多因素分析证实，CMT在PSM之前（HR：0.54，95%CI：0.38 - 0.77，P = 0.001）和之后（HR：0.45，95%CI：0.27 - 0.73，P = 0.001）均与OS改善独立相关。地标性分析表明，接受CMT的患者比单纯接受CT的患者OS更好。亚组分析显示，CMT在大多数亚组中均有OS获益。SHAP值分析表明，CMT是生存结果的最主要贡献因素。SEER数据库验证证实了这些发现。
本研究表明，与单纯CT相比，CMT显著改善了LAUPC和MPC患者的OS。将RT与CT相结合可能有利于LAUPC和MPC的治疗。
