Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study.
Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study.
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DOI：
10.1245/s10434-009-0743-7
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发表时间：
2010-04
影响因子：
3.7
通讯作者：
Miller RC
中科院分区：
文献类型：
--
作者：
Hsu CC;Herman JM;Corsini MM;Winter JM;Callister MD;Haddock MG;Cameron JL;Pawlik TM;Schulick RD;Wolfgang CL;Laheru DA;Farnell MB;Swartz MJ;Gunderson LL;Miller RC
胰腺导管腺癌的生存率很低，辅助治疗的作用仍然存在争议，最近的数据表明，与单独手术相比，辅助放化疗（CRT）可能会降低生存率。我们的目标是检查与单独手术相比，辅助CRT在切除的胰腺癌中的疗效。纳入了约翰霍普金斯医院（n = 794，1993-2005）和马约诊所（n = 478，1985-2005）切除后接受观察（n = 509）或接受基于5-FU的辅助CRT（中位剂量50.4戈伊; n = 583）的胰腺癌患者。考克斯生存和倾向评分分析评估与总生存的相关性。基于机构、年龄、性别、肿瘤大小/分期、分化、切缘和淋巴结阳性，按治疗组（1：1）进行配对分析，N = 496（每个治疗组n = 248）。中位生存期为18.8个月。接受CRT的患者的总生存率（OS）比单纯手术的患者更长（中位生存期21.1 vs. 15.5个月，P <0.001; 2年和5年OS 44.7 vs. 34.6%; 22.3 vs. 16.1%，P <0.001）。在倾向评分分析中，与单纯手术相比，辅助CRT使所有患者的生存率提高了33%（P < .001），按年龄、切缘、淋巴结和T分期分层时，生存率提高（RR = 0.57-0.75，P < .05）。配对分析显示CRT的OS更长（中位生存期为21.9 vs. 14.3个月; 2年和5年OS为45.5 vs. 31.4%; 25.4 vs. 12.2%，P <0.001）。辅助CRT与胰腺切除术后生存率的提高相关。即使在倾向评分和配对分析中，辅助CRT与任何风险组的生存率降低均无关。需要进一步研究评估辅助化疗与辅助放化疗的比较，以确定最有效的全身和局部区域治疗组合，以达到最佳的生存结果。
Survival for pancreatic ductal adenocarcinoma is low, the role of adjuvant therapy remains controversial, and recent data suggest adjuvant chemoradiation (CRT) may decrease survival compared with surgery alone. Our goal was to examine efficacy of adjuvant CRT in resected pancreatic adenocarcinoma compared with surgery alone. Patients with pancreatic adenocarcinoma at Johns Hopkins Hospital (n = 794, 1993–2005) and Mayo Clinic (n = 478, 1985–2005) following resection who were observed (n = 509) or received adjuvant 5-FU based CRT (median dose 50.4 Gy; n = 583) were included. Cox survival and propensity score analyses assessed associations with overall survival. Matched-pair analysis by treatment group (1:1) based on institution, age, sex, tumor size/stage, differentiation, margin, and node positivity with N = 496 (n = 248 per treatment arm) was performed. Median survival was 18.8 months. Overall survival (OS) was longer among recipients of CRT versus surgery alone (median survival 21.1 vs. 15.5 months, P < .001; 2- and 5-year OS 44.7 vs. 34.6%; 22.3 vs. 16.1%, P < .001). Compared with surgery alone, adjuvant CRT improved survival in propensity score analysis for all patients by 33% (P < .001), with improved survival when stratified by age, margin, node, and T-stage (RR = 0.57–0.75, P < .05). Matched-pair analysis demonstrated OS was longer with CRT (21.9 vs. 14.3 months median survival; 2- and 5-year OS 45.5 vs. 31.4%; 25.4 vs. 12.2%, P < .001). Adjuvant CRT is associated with improved survival after pancreaticoduodenectomy. Adjuvant CRT was not associated with decreased survival in any risk group, even in propensity score and matched-pair analyses. Further studies evaluating adjuvant chemotherapy compared with adjuvant chemoradiation are needed to determine the most effective combination of systemic and local–regional therapy to achieve optimal survival results.
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影响因子：
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作者：
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通讯作者：
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DOI：
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