Cao BY, Wang QQ, Zhang LT, Wu CC, Tong F, Yang W, Wang J. Survival benefits and disparities in radiation therapy for elderly patients with pancreatic ductal adenocarcinoma. World J Gastrointest Oncol 2023; 15(1): 155-170 [PMID: 36684051 DOI: 10.4251/wjgo.v15.i1.155]
Corresponding Author of This Article
Jing Wang, PhD, Professor, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. wangjingmd@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Bi-Yang Cao, Qian-Qian Wang, Le-Tian Zhang, Chen-Chen Wu, Fang Tong, Wei Yang, Jing Wang, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Bi-Yang Cao, Le-Tian Zhang, Chen-Chen Wu, Medical School of Chinese PLA, Beijing 100853, China
Author contributions: Cao BY and Wang QQ contributed equally to this work; Cao BY and Wang QQ designed the research and wrote the first manuscript; Zhang LT, Wu CC, and Tong F contributed to conceiving the research and analyzing data; Yang W and Wang J conducted the analysis and provided guidance for the research, and they were co-corresponding authors; all authors reviewed and approved the final manuscript.
Institutional review board statement: Our research is based on the National Cancer Institute's SEER program. For this study, we signed the SEER research data agreement to access SEER information, using reference number 15159-Nov2020. Data were obtained following the approved guidelines. The Office for Human Research Protection considered this research to be on nonhuman subjects because the subjects were patients who had been researched by the United States Department of Health and Human Services and were publicly accessible and de-identified. Thus, no institutional review board approval was required.
Informed consent statement: Patients were not required to give informed consent to the study because this study used a public database with anonymous clinical data and the patients’ personal privacy information was not available.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used or analyzed during the current study are available from the SEER dataset repository (https://seer.cancer.gov/).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Wang, PhD, Professor, Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. wangjingmd@hotmail.com
Received: November 14, 2022 Peer-review started: November 14, 2022 First decision: November 24, 2022 Revised: November 27, 2022 Accepted: December 21, 2022 Article in press: December 21, 2022 Published online: January 15, 2023
ARTICLE HIGHLIGHTS
Research background
Pancreatic ductal adenocarcinoma (PDAC) is primarily a disease of the elderly, with a median age at diagnosis of 70 years. Elderly patients represent a unique subgroup of the cancer patient population, for which the role of cancer therapy requires special consideration.
Research motivation
Radiation therapy (RT) plays an evolving and pivotal role in providing optimal care for patients with PDAC. However, studies evaluating the use and effectiveness of RT for treating PDAC in older patients are scarce.
Research objectives
To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice.
Research methods
Data from patients with PDAC aged ≥ 65 years between 2004 and 2018 were collected from the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression analysis was performed to determine factors associated with RT administration. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using the Kaplan-Meier method with the log-rank test. Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS. Propensity score matching (PSM) was applied to balance the baseline characteristics between the RT and non-RT groups. Subgroup analyses were performed based on clinical characteristics.
Research results
A total of 12245 patients met the inclusion criteria, with 2551 (20.8%) patients who were treated with RT and 9694 (79.2%) who were not. The odds of receiving RT increased with younger age, diagnosis in the earlier period, primary site in the head, localized disease, greater tumor size, and receiving chemotherapy (all P < 0.05). Before PSM, the RT group had better outcomes than did the non-RT group [median OS: 14.0 vs 6.0 mo; hazard ratio (HR) for OS: 0.862, 95% confidence interval (CI): 0.819–0.908, P < 0.001; and HR for CSS: 0.867, 95%CI: 0.823–0.914, P < 0.001]. After PSM, the survival benefit associated with RT remained comparable (median OS: 14.0 vs 11.0 mo; HR for OS: 0.818, 95%CI: 0.768–0.872, P < 0.001; and HR for CSS: 0.816, 95%CI: 0.765–0.871, P < 0.001). Subgroup analysis revealed that the survival benefits (OS and CSS) of RT were more significant in patients aged 65 to 80 years, in regional and distant stages, with no surgery, and receiving chemotherapy.
Research conclusions
The current study demonstrated that elderly PDAC patients who were treated with RT had improved OS and CSS when compared to those patients who were not treated with RT.
Research perspectives
This study adds to the growing literature on retrospective studies on the role of RT in elderly patients with PDAC and highlights the need for a large multicenter randomized trial to further understand this subject.
