Abstract：
BACKGROUND: Adjuvant chemotherapy (AC) following pancreaticoduodenectomy (PD) for pancreas cancer (PDAC) has been demonstrated to improve survival. However, the optimal adjuvant treatment (AT) regimen for R1-margin patients remains unclear. This retrospective study investigates the impact of AC vs. adjuvant chemoradiotherapy (ACRT) on survival (OS).
METHODS: The NCDB was queried for patients with PDAC who underwent PD between 2010 and 2018. Patients were divided into, (A) AC<60 days, (B) ACRT<60 days, (C) AC≥60 days, and (D) ACRT≥60 days. Kaplan-Meier survival analyses and Cox multivariable regression analyses were performed.
RESULTS: Among 13 740 patients, median OS was 23.7 months. For R1 patients, median OS for timely AC and ACRT, and delayed AC and ACRT was 19.91, 19.19, 15.24, 18.96 months, respectively. While time of AC initiation was an insignificant factor for R0 patients (p = 0.263, CI 0.957-1.173), a survival benefit was found for R1 patients who received AC<60 vs. ≥60 days (p = 0.041, CI 1.002-1.42). Among R1 patients, administration of delayed ACRT achieves the same survival benefit of timely AC initiation (p = 0.074, CI 0.703-1.077).
CONCLUSIONS: The study suggests value in ACRT for patients with R1 margins when delay of AT≥60 days cannot be avoided. Hence, ACRT may mitigate the negative impact of delayed AT initiation for R1-patients.
METHODS: The NCDB was queried for patients with PDAC who underwent PD between 2010 and 2018. Patients were divided into, (A) AC<60 days, (B) ACRT<60 days, (C) AC≥60 days, and (D) ACRT≥60 days. Kaplan-Meier survival analyses and Cox multivariable regression analyses were performed.
RESULTS: Among 13 740 patients, median OS was 23.7 months. For R1 patients, median OS for timely AC and ACRT, and delayed AC and ACRT was 19.91, 19.19, 15.24, 18.96 months, respectively. While time of AC initiation was an insignificant factor for R0 patients (p = 0.263, CI 0.957-1.173), a survival benefit was found for R1 patients who received AC<60 vs. ≥60 days (p = 0.041, CI 1.002-1.42). Among R1 patients, administration of delayed ACRT achieves the same survival benefit of timely AC initiation (p = 0.074, CI 0.703-1.077).
CONCLUSIONS: The study suggests value in ACRT for patients with R1 margins when delay of AT≥60 days cannot be avoided. Hence, ACRT may mitigate the negative impact of delayed AT initiation for R1-patients.
摘要：
背景：胰十二指肠切除术（PD）后辅助化疗（AC）治疗胰腺癌（PDAC）已被证明可以提高生存率。然而,R1切缘患者的最佳辅助治疗(AT)方案尚不清楚.这项回顾性研究调查了AC与辅助放化疗（ACRT）对生存（OS）的影响。
方法：向NCDB查询了2010年至2018年间接受PD的PDAC患者。患者分为,(A)AC<60天，（B）ACRT<60天，(C)AC≥60天，（D）ACRT≥60天。进行Kaplan-Meier生存分析和Cox多元回归分析。
结果：在13.740名患者中，中位OS为23.7个月.对于R1患者，及时AC和ACRT的中位OS，延迟AC和ACRT分别为19.91、19.19、15.24、18.96个月，分别。虽然AC开始时间是R0患者的一个无关紧要的因素（p=0.263，CI0.957-1.173），发现接受AC<60的R1患者的生存获益与≥60天（p=0.041，CI1.002-1.42）。在R1患者中，延迟ACRT的给药实现了与及时AC开始相同的生存益处(p=0.074,CI0.703-1.077)。
结论：研究表明，当AT≥60天的延迟无法避免时，对于R1边缘患者，ACRT具有价值。因此，ACRT可以减轻R1患者延迟AT启动的负面影响。
方法：向NCDB查询了2010年至2018年间接受PD的PDAC患者。患者分为,(A)AC<60天，（B）ACRT<60天，(C)AC≥60天，（D）ACRT≥60天。进行Kaplan-Meier生存分析和Cox多元回归分析。
结果：在13.740名患者中，中位OS为23.7个月.对于R1患者，及时AC和ACRT的中位OS，延迟AC和ACRT分别为19.91、19.19、15.24、18.96个月，分别。虽然AC开始时间是R0患者的一个无关紧要的因素（p=0.263，CI0.957-1.173），发现接受AC<60的R1患者的生存获益与≥60天（p=0.041，CI1.002-1.42）。在R1患者中，延迟ACRT的给药实现了与及时AC开始相同的生存益处(p=0.074,CI0.703-1.077)。
结论：研究表明，当AT≥60天的延迟无法避免时，对于R1边缘患者，ACRT具有价值。因此，ACRT可以减轻R1患者延迟AT启动的负面影响。
