Predictors of Locoregional Failure and the Impact on Overall Survival in Patients with Resected Exocrine Pancreas Cancer
Menée à partir de données portant sur 1 051 patients atteints d'un cancer non métastatique du pancréas exocrine traité par résection entre 1985 et 2011 (âge médian : 64,5 ans ; durée médiane de suivi : 84 mois), cette étude identifie les facteurs prédictifs associés à un échec locorégional, puis évalue l'association entre échec locorégional et survie globale des patients
Purpose/Objectives : Resection of exocrine pancreas cancer is necessary for cure, but locoregional and distant relapse is common. We evaluated our institutional experience to better understand risk factors for locoregional failure (LRF) and its impact on overall survival (OS).
Methods and Materials : We reviewed 1,051 consecutive patients with nonmetastatic exocrine pancreas cancer who underwent resection at our institution between March 1985 and January 2011. Among them, 458 had adequate follow-up and evaluation for study inclusion. All patients received adjuvant chemotherapy (n=80 [17.5%]) or chemoradiotherapy (n=378 [82.5%]). Chemotherapy and chemoradiotherapy most frequently consisted of 6 cycles of gemcitabine and 50.4 Gy in 28 fractions with concurrent 5-fluorouracil. Locoregional control (LRC) and OS were estimated with the Kaplan-Meier method. Univariate and multivariable analyses were performed with Cox proportional hazards regression models incorporating propensity score.
Results : Median (range) patient age was 64.5 (29-88) years. Median (range) follow-up for living patients was 84 (6-300) months. Extent of resection was R0 (83.8%) or R1 (16.2%). Overall crude incidence of LRF was 17% (n=79). The 5-year LRC for patients with and without radiotherapy was 80% vs 68% (P=.003; hazard ratio [HR] [95% CI], 0.45 [0.28-0.76]). Multivariable analysis, incorporating propensity score, indicated radiotherapy (P<.0001; HR [95% CI], 0.23 [0.12-0.42]) and positive lymph node ratio of ≥0.2 (P=.02; HR [95% CI], 1.78 [1.10-2.9]) were associated with LRC. In addition, LRF was associated with worse OS (P<.0001; HR [95% CI], 5.0 [3.9-6.3]).
Conclusions : In our analysis of 458 patients with resected pancreas cancer, positive lymph node ratio of ≥0.2 and no adjuvant chemoradiotherapy were associated with increased LRF risk. LRF was associated with poor OS. Radiotherapy should be considered adjuvant locoregional treatment in pancreas cancer resection.
International Journal of Radiation Oncology • Biology • Physics , résumé, 2014