Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Sep 24, 2020; 11(9): 747-760
Published online Sep 24, 2020. doi: 10.5306/wjco.v11.i9.747
Comparison of efficacy between adjuvant chemotherapy and chemoradiation therapy for pancreatic cancer: AJCC stage-based approach
Min Su You, Ji Kon Ryu, Gunn Huh, Jung Won Chun, Woo Hyun Paik, Sang Hyub Lee, Yong-Tae Kim
Min Su You, Ji Kon Ryu, Gunn Huh, Jung Won Chun, Woo Hyun Paik, Sang Hyub Lee, Yong-Tae Kim, Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul 110-744, South Korea
Author contributions: You MS and Ryu JK contributed to the conceptualization and methodology; You MS contributed to data collection; Huh G, Chun JW and Paik WH contributed to collect resources; Lee SH and Kim YT contributed to supervision; You MS and Ryu JK contributed to manuscript writing; Huh G and Ryu JK contributed to critical revision; all authors read and approved the final manuscript.
Supported by Seoul National University College of Medicine Research Fund (2017).
Institutional review board statement: This study was approved by Institutional Review Board of the Seoul National University Hospital, Seoul, South Korea (1609-015-789).
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Data are available from the corresponding author on a reasonable request.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ji Kon Ryu, MD, PhD, Doctor, Professor, Internal Medicine and Liver Research Institute, Seoul National University Hospital, 101 Daehangno, Chongno-gu, Seoul 110-744, South Korea. jkryu@snu.ac.kr
Received: April 3, 2020
Peer-review started: April 3, 2020
First decision: April 18, 2020
Revised: August 5, 2020
Accepted: August 24, 2020
Article in press: August 24, 2020
Published online: September 24, 2020
ARTICLE HIGHLIGHTS
Research background

The adjuvant treatment for pancreatic cancer is not yet standardized. There are discrepancies among previous studies comparing the efficacy of adjuvant chemoradiation therapy (CRT) and systemic chemotherapy (SCT).

Research motivation

Recently, the American Joint Committee on Cancer (AJCC) 8th subdivided N1 into N1 and N2. Because the prognosis differs according to the AJCC stage, a tailored approach to establish more aggressive treatment plans in high-risk patients is necessary. However, studies comparing the efficacy of adjuvant treatment modalities according to the AJCC stage are largely lacking.

Research objectives

This retrospective study was conducted to compare the efficacy of CRT, SCT and a combination of both therapies (CRT-SCT) according to the AJCC 8th staging system in patients with resected pancreatic cancer.

Research methods

Data on 335 patients who underwent surgical resection and adjuvant treatment for pancreatic cancer between September 2005 and December 2017 were retrospectively reviewed. Patients were divided into three groups: CRT group, SCT group and CRT-SCT group. The primary outcome was overall survival (OS) in the three groups.

Research results

Patients received CRT (n = 65), SCT (n = 62) and CRT-SCT (n = 208). Overall median OS was 33.3 mo (95%CI: 27.4-38.6). In patients with stage I/II, the median OS was 27.0 mo (95%CI: 2.06-89.6) in the CRT group, 35.8 mo (95%CI: 26.9-NA) in the SCT group and 38.6 mo (95%CI: 33.3-55.7) in the CRT-SCT group. Among them, there was no significant difference in OS between the three groups. In 59 patients with stage III, median OS in the SCT group [19.0 mo (95%CI: 12.6-NA)] and CRT-SCT group [23.4 mo (95%CI: 22.0-44.4)] was significantly longer than in the CRT group [17.7 mo(95%CI: 6.8-NA); P = 0.011 and P < 0.001, respectively].

Research conclusions

The study has concluded that SCT with or without CRT might be a reasonable choice preferentially over CRT in patients with AJCC stage III.

Research perspectives

The adjuvant treatment for pancreatic cancer is not yet standardized. In this study, SCT and CRT-SCT showed significantly longer OS and recurrence-free survival than CRT in patients with AJCC stage III, while there was no significant difference in OS between CRT, SCT and CRT-SCT groups in patients with AJCC stage I/II. Different adjuvant therapy according to AJCC stage can be applied in patients with PC.