Introduction

The impact of adjuvant sequential chemoradiotherapy (CRT) on survival in resected pancreatic ductal adenocarcinoma (PDAC) remains unclear and warrants further investigation.

Methods

NCDB patients with R0/R1 resected PDAC who received adjuvant chemotherapy without CRT or followed by CRT per RTOG-0848 protocol were included. Cox regression for 5-year overall survival (OS) was performed and used to construct a pathologic nomogram in patients who did not receive CRT. A risk score was calculated and patients were divided into low-risk and high-risk groups. Patients from each risk stratum were matched for the receipt of CRT to assess the added benefit of CRT on survival. The Kaplan–Meier analysis was performed to compare OS.

Results

A total of 7146 patients were selected, 1308 (18.3%) received CRT per RTOG-0848. Cox regression concluded grade, T stage, N stage, node yield < 12, R1, and LVI as significant predictors of 5-year OS which were used to construct the risk score. Matched analysis in low-risk patients (score 0–79) showed no difference in OS between CRT vs. no CRT (47.6 ± 5.7 vs. 45.1 ± 3.9 months; p = 0.847). OS benefit was 3% at 1 year, − 4% at 2 years, and 4% at 5 years. In high-risk patients (score 80–100), median OS was higher in CRT vs. no CRT (24.8 ± 0.7 vs. 21.7 ± 0.8 months; p = 0.043). Absolute OS benefit was 13% at 1 year, 5% at 2 years, and − 1% at 5 years.

Conclusion

CRT has a short-lived impact on OS in resected PDAC that is only evident in high-risk patients. In this subset, survival benefit peaks at 1 year and subsides at 3 to 5 years following PDAC resection.

中文翻译：

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切除的胰腺导管腺癌的辅助放化疗：好处在哪里？风险分层和患者选择的列线图

介绍

辅助序贯放化疗 (CRT) 对切除的胰腺导管腺癌 (PDAC) 生存率的影响仍不清楚，需要进一步研究。

方法

R0/R1 切除 PDAC 的 NCDB 患者包括接受辅助化疗而不使用 CRT 或按照 RTOG-0848 协议进行 CRT。对 5 年总生存率 (OS) 进行 Cox 回归并用于构建未接受 CRT 患者的病理列线图。计算风险评分并将患者分为低风险组和高风险组。来自每个风险等级的患者都匹配接受 CRT，以评估 CRT 对生存的额外益处。进行 Kaplan-Meier 分析以比较 OS。

结果

总共选择了 7146 名患者，1308 名 (18.3%) 根据 RTOG-0848 接受了 CRT。Cox 回归得出分级、T 分期、N 分期、结节产量 < 12、R1 和 LVI 作为 5 年 OS 的重要预测因子，用于构建风险评分。低风险患者的匹配分析（0-79 分）显示 CRT 与无 CRT 之间的 OS 没有差异（47.6 ± 5.7 与 45.1 ± 3.9 个月；p  = 0.847）。OS 获益在 1 年时为 3%，在 2 年时为 - 4%，在 5 年时为 4%。在高危患者（80-100 分）中，CRT 的中位 OS 高于无 CRT（24.8 ± 0.7 与 21.7 ± 0.8 个月；p  = 0.043）。绝对 OS 获益在 1 年时为 13%，在 2 年时为 5%，在 5 年时为 - 1%。

结论

CRT 对切除的 PDAC 的 OS 有短暂的影响，这仅在高危患者中明显。在该亚组中，生存获益在 PDAC 切除术后 1 年达到峰值，并在 3 至 5 年消退。