The Survival Effect of Radiotherapy on Stage IIB/III Pancreatic Cancer Undergone Surgery in Different Age and Tumor Site Groups: A Propensity Scores Matching Analysis Based on SEER Database

Abstract

BackgroundIt 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.MethodsThe 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.ResultsNeither 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.ConclusionCarefully 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.

Selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy

“…Circulating tumour cells that enter peripheral blood are thought to contribute to metastatic disease with worse survival [ 77 ]. In an analysis of the Surveillance, Epidemiology, and End Results database, patients with PDAC with a tumour location over the pancreatic head, stage II/III cancer, T4 cancer, N1 cancer, regional resection, or lymphadenectomy of ≥ 4 lymph nodes were demonstrated to benefit from adjuvant radiotherapy [ 78 , 79 ]. Several studies have revealed that a combined analysis of radiomic features, clinical parameters, pathology score, and tissue/serum biomarkers improves the prognostic power of clinical outcomes in PDAC [ 32 , 80 ].…”

Changes in Pancreatic Senescence Mediate Pancreatic Diseases

“…Nonetheless, the latest data did not support that increasing RT in young patients improved prognosis or had greater survival benefit than in older patients. However, young people can undergo more extensive surgery and chemoradiotherapy [ 78 , 79 ]. Health conditions such as frailty may be more closely associated with radiation toxicity.…”

Incidence trends and survival analysis of appendiceal tumors in the United States: Primarily changes in appendiceal neuroendocrine tumors

“…Patients were grouped by year of diagnosis (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) for demographic and clinical characteristics, including race, age, gender, marital status, tumor grade (I, II, III/IV), summary stage (localized, regional, distant) and treatment information (surgery and chemotherapy). With reference to previous studies, Grade III and Grade IV were reclassified into one category for the analysis [9,10]. Localized stage means that the tumor is confined to the appendix (T1-3) and there is no metastasis to lymph nodes or other organs or tissues.…”