C. Mosquera1, L. M. Hunter1, T. L. Fitzgerald1 1East Carolina University Brody School Of Medicine,Surgical Oncology,Greenville, NC, USA
Introduction: Postoperative adjuvant therapy for pancreatic adenocarcinoma has engendered significant controversy and is the subject of yet to be completed clinical trials. Pending these trials, data to guide optimal patient management is needed.
Methods: Patients with resected adenocarcinomas of the pancreas undergoing surgery only, postoperative chemotherapy (CT), and chemoradiotherapy (CRT) from 2004-2013 were identified using the NCDB.
Results: A total of 26,821 patients were included. A majority were male (50.6%), white (86.3%), stage of II (82.4%), and with a Charlson comorbidity score of 0 (67.7%). On univariate analysis, adjuvant therapy was most strongly associated with younger age, race, insurance status, lymphatic invasion, high grade, and size > 2cm., p<.0001. On multivariate analysis, the associations continued for age <50 years (OR 5.24), lymphatic invasion (OR 1.60), high-grade (OR 1.37) and size > 2cm (OR 1.35), but not race or insurance status. On univariate survival analysis, patients that received adjuvant therapy had a greater median survival compared to surgery alone (22.0 vs 18.2 months, p<.0001). On multivariate survival analysis adjuvant therapy continued to be associated with survival (1.39, p<.0001). A total of 16,549 patients received postoperative CT or CRT. On univariate analysis patients who were older, had negative margins, and with Medicare were most likely to receive CT, p<.0001. On multivariate analysis age and negative margins were significant (OR 1.73, p<.0001), lymphatic invasion, tumor size, and insurance status were not. When survival analysis was restricted to those receiving CT or CRT, the highest median survival was seen in low grade (31.2 months, p<.0001) and size < 2cm. (33.1 months, p<.0001). Patients who received CRT had longer median survival than those who received CT (22.9 vs 21.8 months, p=.0001). On multivariate analysis of CT vs CRT (HR 1.14), high grade (HR 1.64), positive margins (HR 1.53), and lymphatic invasion (HR 1.50) continue to be associated with diminished survive, p <0.0001.
Conclusion: Postoperative adjuvant therapy is associated with a 40% improved survival. In contrast to other studies, these data suggest a modest survival advantage to combination therapy compared to CT alone.
