Impact of Adjuvant Radiotherapy on Survival after Pancreatic Cancer Resection: An Appraisal of Data from the National Cancer Data Base

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• 作者：David A. Kooby MD (1) (2) (3)
  Theresa W. Gillespie PhD ; MA (1) (2) (3)
  Yuan Liu PhD (3) (4)
  Johnita Byrd-Sellers MS (2)
  Jerome Landry MD (3) (5)
  John Bian PhD (6)
  Joseph Lipscomb PhD (3) (7)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2013
• 出版时间：October 2013
• 年：2013
• 卷：20
• 期：11
• 页码：3634-3642
• 全文大小：281KB
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• 作者单位：David A. Kooby MD (1) (2) (3)
  Theresa W. Gillespie PhD, MA (1) (2) (3)
  Yuan Liu PhD (3) (4)
  Johnita Byrd-Sellers MS (2)
  Jerome Landry MD (3) (5)
  John Bian PhD (6)
  Joseph Lipscomb PhD (3) (7)
  
  1. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
  2. Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
  3. Winship Cancer Institute of Emory University, Atlanta, GA, USA
  4. Department of Biostatistics and Bioinformation, Rollins School of Public Health, Emory University, Atlanta, GA, USA
  5. Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
  6. Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Charleston, SC, USA
  7. Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
  

文摘

Purpose The impact of adjuvant radiotherapy for pancreatic adenocarcinoma (PAC) remains controversial. We examined effects of adjuvant therapy on overall survival (OS) in PAC, using the National Cancer Data Base (NCDB). Methods Patients with resected PAC from 1998 to 2002 were queried from the NCDB. Factors associated with receipt of adjuvant chemotherapy (ChemoOnly) versus adjuvant chemoradiotherapy (ChemoRad) versus no adjuvant treatment (NoAdjuvant) were assessed. Cox proportional hazard modeling was used to examine effect of adjuvant therapy type on OS. Propensity scores (PS) were developed for each treatment arm and used to produce matched samples for analysis to minimize selection bias. Results From 1998 to 2002, a total of 11,526 patients underwent resection of PAC. Of these, 1,029 (8.9?%) received ChemoOnly, 5,292 (45.9?%) received ChemoRad, and 5,205 (45.2?%) received NoAdjuvant. On univariate analysis, factors associated with improved OS included: younger age, higher income, higher facility volume, lower tumor stage and grade, negative margins and nodes, and absence of adjuvant therapy. On multivariate analysis with matched PS, factors independently associated with improved OS included: younger age, higher income, higher facility volume, later year of diagnosis, smaller tumor size, lower tumor stage, and negative tumor margins and nodes. ChemoRad had the best OS (hazard ratio 0.70, 95?% confidence interval 0.61-.80) in a PS matched comparison with ChemoOnly (hazard ratio 1.04, 95?% confidence interval 0.93-.18) and NoAdjuvant (index). Conclusions Adjuvant chemotherapy with radiotherapy is associated with improved OS after PAC resection in a large population from the NCDB. On the basis of these analyses, radiotherapy should be a part of adjuvant therapy for PAC.