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• W2972342609 abstract "The literature has been conflicting on the superiority of adjuvant chemoradiation over chemotherapy for node-positive adenocarcinoma of the pancreas following definitive surgery. Both options are reflected in the National Comprehensive Cancer Network guidelines. We aimed to evaluate the patterns of care and outcomes of these two treatment options using the National Cancer Database (NCDB). Patients diagnosed with non-metastatic, node-positive adenocarcinoma of the pancreas from 2006-2014 who received oncologic resection with negative margins followed by adjuvant chemotherapy or chemoradiation were identified in the NCDB. External beam radiation therapy dose was limited to 4500-5400cGy and the cohort was further selected to exclude those who lived less than 3 months or received any neoadjuvant therapy. Patient- and clinical-related factors were compared between those who received adjuvant chemotherapy alone (aC) versus adjuvant chemoradiation (aCRT). Univariable and multivariable logistic regression was performed to assess for predictors of adjuvant chemoradiation use. The Kaplan-Meier method was used to assess overall survival (OS) and univariable and multivariable Cox regression analysis was used to assess impact of covariables on OS. There were 3,609 patients who met the study criteria, of which 2,988 (82.8%) received chemotherapy alone and 621 (17.2%) who received chemoradiation. Median follow up for living patients was 33.8 months (IQR 22-51). Two-year OS for those who received chemotherapy alone was 44.9% and for chemoradiation was 42.6% (p=0.169). On multivariable logistic regression, those who received treatment at an academic facility (OR 0.479, 95% CI 0.39-0.58, p<0.001), highest median income quartile (OR 0.668, 95% CI 0.50-0.90, p=0.009) and more recent years of diagnoses 2009-2014 (OR 0.21-0.37, p<0.001) were less likely to receive aCRT over aC. Patients treated in the South (OR 1.55, 95% CI 1.17-2.04, p=0.002) were more likely to receive aCRT. On multivariable survival analysis, age group ≥60 (HR 1.10, 95% CI 1.02-1.20, p=0.021), Black race (HR 1.16, 95% CI 1.01-1.32, p=0.034), and Charlson-Deyo comorbidity score ≥1 (HR 1.11-1.37, p<0.05) were associated with worse survival. Treatment at an academic facility (HR 0.85, 95% CI 0.78-0.92, p<0.001), highest median income quartile (HR 0.85, 95% CI 0.76-0.96, p=0.010) and more recent years of diagnoses 2009-2014 (HR 0.80-0.90, p<0.05) were associated with improved survival. The treatment variable of interest was not associated with any differences in survival. Adjuvant chemotherapy alone following surgical resection for adenocarcinoma of the pancreas is the predominant treatment of choice among U.S. hospitals. There was no overall survival benefit noted in those who were treated with adjuvant chemoradiation." @default.
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• W2972342609 date "2019-09-01" @default.
• W2972342609 modified "2023-09-24" @default.
• W2972342609 title "Patterns of Care and Outcomes of Adjuvant Chemoradiation for Node-Positive Pancreatic Adenocarcinoma" @default.
• W2972342609 doi "https://doi.org/10.1016/j.ijrobp.2019.06.2015" @default.
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