Impact of Adjuvant Chemoradiotherapy on Survival of Resected Pancreatic Adenocarcinoma Cancer: A Surveillance, Epidemiology and End Results (SEER) Analysis

Abstract

BackgroundThe benefits of postoperative adjuvant chemoradiotherapy (CRT) for pancreatic cancer remain controversial. The purpose of this study is to determine if adjuvant CRT can improve the overall survival of postoperative pancreatic cancer patients compared to adjuvant chemotherapy (CT).MethodsPatients with resected pancreas adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016). Multivariate Cox regression was used to determine the factors related to survival rate. Selection bias was reduced to a minimum through propensity matching analysis. Subgroup analyses by clinical characteristics were performed.ResultsThis study identified 10,097 patients who received adjuvant CT (n = 5,454) or adjuvant CRT (n = 4,643). On multivariate analysis, age, sex, tumor size, site, grade, stage, T stage, and lymph node metastasis were independent risk factors for OS. The basic clinical characteristics were well balanced after propensity matching. After propensity matching, CRT can improve the survival rate compared with CT [median OS: 22 months vs 23 months (HR, 0.928; 95% CI, 0.881–0.977; P = 0.004)]. Subgroup analysis indicated that the survival benefit of adjuvant chemoradiotherapy was more significant in patients with female (HR, 0.860; 95% CI, 0.798–0.926; P = 0.005 for interaction) or T3 (HR, 0.905; 95% CI, 0.855–0.957; P = 0.04 for interaction) or lymph nodes positive (HR, 0.883; 95% CI, 0.832–0.938; P = 0.005 for interaction).ConclusionAdjuvant CRT was associated with improved survival compared with adjuvant CT in patients with resection of pancreatic ductal adenocarcinoma. The benefit was more significant in patients with female or T3 or lymph nodes positive.

How A Patient with Resectable or Borderline Resectable Pancreatic Cancer should Be Treated—A Comprehensive Review

“…On the other hand, in the retrospective analysis based on the SEER (Surveillance, Epidemiology and End Results) database, adjuvant CRT was associated with improved survival compared with adjuvant chemotherapy in particular subgroups of patients. The benefit was more significant in patients who were females (HR = 0.860; p = 0.005) and had pT3 (HR = 0.905; p = 0.04) and positive lymph nodes (HR = 0.88; p = 0.005) [30].…”

The evolving role of radiation in pancreatic cancer

“…In contrast, adjuvant chemoradiotherapy demonstrated improvement in OS compared to adjuvant chemotherapy (HR, 0.9; 95%CI, 0.881-0.977; p=0.004) in patients with resected pancreas adenocarcinoma based on a Surveillance, Epidemiology, and End Results (SEER) database analyses from 2004-2016. This benefit was more pronounced in females and patients with positive lymph node detected on surgical pathology ( 16 ).…”

Neoadjuvant and Adjuvant Chemotherapy for Pancreatic Adenocarcinoma: Literature Review and Our Experience of NAC-GS

“…On the other hand, the significance of adjuvant chemoradiotherapy (CRT) has not yet been established. The ESPAC-1 and EORTIC trial 40,891 showed no additional benefit of adjuvant CRT in patients with PDAC [ 18 ]; however, in one retrospective cohort study, some patients benefited more from adjuvant CRT than from adjuvant CT [ 19 ].…”