Association of Adjuvant Radiotherapy With Survival After Margin-negative Resection of Pancreatic Ductal Adenocarcinoma: A Propensity-matched National Cancer Database (NCDB) Analysis.

Annals of Surgery
Sivesh K KamarajahHari Nathan

Abstract

There is conflicting evidence for the benefit of adjuvant radiotherapy (RT) after resection of pancreatic ductal adenocarcinoma (PDAC), especially for margin-negative (R0) resections. We aimed to evaluate the association of adjuvant RT with survival after R0 resection of PDAC. Using National Cancer Database (NCDB) data from 2004 to 2013, we identified patients with R0 resection of nonmetastatic PDAC. Patients with neoadjuvant radiotherapy and chemotherapy and survival <6 months were excluded. Propensity score matching was used to account for treatment selection bias. A multivariable Cox proportional hazards model was then used to analyze the association of RT with survival. Of 4547 (36%) RT and 7925 (64%) non-RT patients, 3860 RT and 3860 non-RT patients remained in the cohort after matching. Clinicopathologic and demographic variables were well balanced after matching. Lymph node metastases were present in 68% (44% N1, 24% N2). After matching, RT was associated with higher survival (median 25.8 vs 23.9 mo, 5-yr 27% vs 24%, P < 0.001). After multivariable adjustment, RT remained associated with a survival benefit (HR 0.89, 95% CI 0.84-0.94, P < 0.001). Stratified and multivariable interaction analyses showed that this benefit w...Continue Reading

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Citations

Jun 14, 2020·The British Journal of Surgery·S K KamarajahA W Phillips
Jan 25, 2020·Annals of Surgical Oncology·S K KamarajahA W Phillips
Jun 20, 2020·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Anantha MadhavanAlexander W Phillips
May 18, 2020·ANZ Journal of Surgery·Sivesh K KamarajahBenjamin Loveday
Jun 10, 2020·JGH Open : an Open Access Journal of Gastroenterology and Hepatology·Hui Lu GohMark Goldstein
Nov 25, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Sivesh K KamarajahHari Nathan
Nov 2, 2019·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Sivesh K KamarajahSteven A White
Mar 1, 2021·The British Journal of Surgery·J Ng Cheong ChungA W Phillips

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