Adjuvant radiotherapy in the treatment of invasive intraductal papillary mucinous neoplasm of the pancreas: an analysis of the surveillance, epidemiology, and end results registry.
Abstract
BACKGROUND: Management and outcomes of patients with invasive intraductal papillary
mucinous neoplasm (IPMN) of the pancreas are not well established. We investigated
whether adjuvant radiotherapy (RT) improved cancer-specific survival (CSS) and overall
survival (OS) among patients undergoing surgical resection for invasive IPMN. METHODS:
The Surveillance, Epidemiology, and End Results (SEER) registry was used in this retrospective
cohort study. All adult patients with resection of invasive IPMN from 1988 to 2007
were included. CSS and OS were analyzed using Kaplan-Meier curves. Unadjusted and
propensity-score-adjusted Cox proportional-hazards modeling were used for subgroup
analyses. RESULTS: 972 patients were included. Adjuvant RT was administered to 31.8%
(n=309) of patients. There was no difference in overall median CSS or OS in patients
who received adjuvant RT (5-year CSS: 26.5 months; 5-year OS: 23.5 months) versus
those who did not (CSS: 28.5 months, P=0.17; OS: 23.5 months, P=0.23). Univariate
predictors of survival were lymph node (LN) involvement, T4-classified tumors, and
poorly differentiated tumor grade (all P<0.05). In the propensity-score-adjusted analysis,
adjuvant RT was associated with improved 5-year CSS [hazard ratio (HR): 0.67, P=0.004]
and 5-year OS (HR: 0.73, P=0.014) among all patients with LN involvement, though further
analysis by T-classification demonstrated no survival differences among patients with
T1/T2 disease; patients with T3/T4-classified tumors had improved CSS (HR: 0.71, P=0.022)
but no difference in OS (HR: 0.76, P=0.06). CONCLUSION: On propensity-score-adjusted
analysis, adjuvant RT was associated with improved survival in selected subsets of
patients with invasive IPMN, particularly those with T3/T4 tumors and LN involvement.
Type
Journal articleSubject
Adenocarcinoma, MucinousAged
Carcinoma, Pancreatic Ductal
Cohort Studies
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Grading
Pancreatic Neoplasms
Radiotherapy, Adjuvant
Registries
Retrospective Studies
Survival Rate
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https://hdl.handle.net/10161/14842Published Version (Please cite this version)
10.1245/s10434-011-2088-2Publication Info
Worni, M; Akushevich, I; Gloor, B; Scarborough, J; Chino, JP; Jacobs, DO; ... Shah,
A (2012). Adjuvant radiotherapy in the treatment of invasive intraductal papillary mucinous
neoplasm of the pancreas: an analysis of the surveillance, epidemiology, and end results
registry. Ann Surg Oncol, 19(4). pp. 1316-1323. 10.1245/s10434-011-2088-2. Retrieved from https://hdl.handle.net/10161/14842.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Igor Akushevich
Research Professor in the Social Science Research Institute
Junzo Paul Chino
Associate Professor of Radiation Oncology
Clinical Research in Gynecologic Malignancies, Breast Malignancies, Radiation Oncology
Resident Education, Stereotactic Radiation Therapy, and Brachytherapy
John Emerson Scarborough
AssociateProfessor of Surgery
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Mathias Worni
Medical Instructor in the Department of Surgery
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
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