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A national propensity-adjusted analysis of adjuvant radiotherapy in the treatment of resected pancreatic adenocarcinoma
Authors
McDade, Theodore P.Hill, Joshua S.
Simons, Jessica P.
Piperdi, Bilal
Ng, Sing Chau
Zhou, Zheng
Kadish, Sidney P.
FitzGerald, Thomas J
Tseng, Jennifer F.
Document Type
Journal ArticlePublication Date
2010-06-22Keywords
AdenocarcinomaAge Factors
Aged
Combined Modality Therapy
Female
Humans
Male
Middle Aged
Pancreatic Neoplasms
Propensity Score
*Radiotherapy, Adjuvant
Sex Factors
Survival Analysis
Surgery
Metadata
Show full item recordAbstract
BACKGROUND: The benefit of adjuvant radiotherapy (RT) for resected pancreatic adenocarcinoma remains controversial after randomized clinical trials. In this national-level US study, a propensity score (conditional probability of receiving RT) was used to adjust for potential confounding in nonrandomized designs from treatment group differences. METHODS: Patients were identified from the Surveillance, Epidemiology, and End Results (SEER) registry (1988-2005 dataset). Multivariate analyses to determine the effect of RT on overall survival were performed using propensity-adjusted Cox proportional hazards and Kaplan-Meier analyses. RESULTS: In total, 5676 patients with resected pancreatic adenocarcinoma were identified, and 40.8% of those patients had received adjuvant RT. Univariate predictors of survival included age, race, marital status, disease stage, tumor size, tumor extension, tumor grade, lymph node status, year of diagnosis, type of resection, and receipt of RT (all P < .002). In a Cox model, independent predictors of improved survival included white race, married status, earlier stage, smaller tumors, well differentiated tumors, negative lymph node (N0) status, recent diagnosis, and receipt of RT (all P < .05). In a propensity-adjusted proportional hazards regression, the benefit of adjuvant treatment that included RT remained significant after adjusting for the likelihood of receiving RT (hazard ratio, 0.773; 95% confidence interval, 0.714-0.836; P < .0001). Within all 5 propensity strata, Kaplan-Meier survival differed significantly (P < .0001 [lowest and highest probability strata] and P = .0165 [middle stratum with a "pseudorandom" probability of RT]). CONCLUSIONS: Adjuvant RT for resected pancreatic adenocarcinoma was associated with a significant survival advantage in a large national database, even after using propensity score methods to adjust for differences between treatment groups. The authors concluded that adjuvant RT should be considered for all appropriate patients who have resected pancreatic adenocarcinoma.Source
Cancer. 2010 Jul 1;116(13):3257-66. Link to article on publisher's siteDOI
10.1002/cncr.25069Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49816PubMed ID
20564625Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1002/cncr.25069