Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Sep 24, 2020; 11(9): 747-760
Published online Sep 24, 2020. doi: 10.5306/wjco.v11.i9.747
Comparison of efficacy between adjuvant chemotherapy and chemoradiation therapy for pancreatic cancer: AJCC stage-based approach
Min Su You, Ji Kon Ryu, Gunn Huh, Jung Won Chun, Woo Hyun Paik, Sang Hyub Lee, Yong-Tae Kim
Min Su You, Ji Kon Ryu, Gunn Huh, Jung Won Chun, Woo Hyun Paik, Sang Hyub Lee, Yong-Tae Kim, Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul 110-744, South Korea
Author contributions: You MS and Ryu JK contributed to the conceptualization and methodology; You MS contributed to data collection; Huh G, Chun JW and Paik WH contributed to collect resources; Lee SH and Kim YT contributed to supervision; You MS and Ryu JK contributed to manuscript writing; Huh G and Ryu JK contributed to critical revision; all authors read and approved the final manuscript.
Supported by Seoul National University College of Medicine Research Fund (2017).
Institutional review board statement: This study was approved by Institutional Review Board of the Seoul National University Hospital, Seoul, South Korea (1609-015-789).
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Data are available from the corresponding author on a reasonable request.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ji Kon Ryu, MD, PhD, Doctor, Professor, Internal Medicine and Liver Research Institute, Seoul National University Hospital, 101 Daehangno, Chongno-gu, Seoul 110-744, South Korea. jkryu@snu.ac.kr
Received: April 3, 2020
Peer-review started: April 3, 2020
First decision: April 18, 2020
Revised: August 5, 2020
Accepted: August 24, 2020
Article in press: August 24, 2020
Published online: September 24, 2020
Processing time: 168 Days and 19.1 Hours
Abstract
BACKGROUND

The adjuvant treatment for patients with resected pancreatic cancer (PC) is not yet standardized. Because the prognosis differs according to the American Joint Committee on Cancer (AJCC) stage, a tailored approach to establish more aggressive treatment plans in high-risk patients is necessary. However, studies comparing the efficacy of adjuvant treatment modalities according to the AJCC stage are largely lacking.

AIM

To compare the efficacy of chemotherapy and chemoradiation therapy according to AJCC 8th staging system in patients with PC who underwent surgical resection.

METHODS

A total of 335 patients who underwent surgical resection and adjuvant treatment for PC were included. Patients were divided into three groups: Chemoradiation therapy (CRT) group, systemic chemotherapy (SCT) group and combined treatment of chemoradiation plus chemotherapy therapy (CRT-SCT) group. The primary outcomes were differences in overall survival (OS) between the three groups. The secondary outcomes were differences in recurrence-free survival, recurrence pattern and adverse events between the three groups.

RESULTS

Patients received CRT (n = 65), SCT (n = 62) and CRT-SCT (n = 208). Overall median OS was 33.3 mo (95% confidence interval (CI): 27.4-38.6). In patients with stage I/II, the median OS was 27.0 mo (95%CI: 2.06-89.6) in the CRT group, 35.8 mo (95%CI: 26.9-NA) in the SCT group and 38.6 mo (95%CI: 33.3-55.7) in the CRT-SCT group. Among them, there was no significant difference in OS between the three groups. In 59 patients with stage III, median OS in the SCT group [19.0 mo (95%CI: 12.6-NA)] and the CRT-SCT group [23.4 mo (95%CI: 22.0-44.4)] was significantly longer than that in the CRT group [17.7 mo (95%CI: 6.8-NA); P = 0.011 and P < 0.001, respectively]. There were no significant differences in incidence of locoregional and distant recurrences between the three groups (P = 0.158 and P = 0.205, respectively). Incidences of grade 3 or higher hematologic adverse events were higher in the SCT and CRT-SCT groups than in the CRT group.

CONCLUSION

SCT and CRT-SCT showed significantly longer OS and recurrence-free survival than CRT in patients with AJCC stage III, while there was no significant difference in OS between the CRT, SCT and CRT-SCT groups in patients with AJCC stage I/II. Different adjuvant therapy according to AJCC stage can be applied in patients with PC.

Keywords: Pancreatic cancer; Adjuvant chemotherapy; Radiotherapy; Survival

Core Tip: We retrospectively reviewed 335 patients who underwent surgical resection and adjuvant treatment for pancreatic cancer. Patients were divided into three groups; chemoradiation therapy (CRT), systemic chemotherapy (SCT) and CRT-SCT. In patients with stage III cancer, median overall survival in the SCT and CRT-SCT groups was significantly longer than that in the CRT group. On the other hand, there was no significant difference in overall survival between CRT, SCT and CRT-SCT in those with stage I/II. SCT with or without CRT might be a reasonable choice preferentially over CRT in patients with American Joint Committee on Cancer stage III.