Adjuvant Radiotherapy in the Treatment of Invasive Intraductal Papillary Mucinous Neoplasm of the Pancreas: an Analysis of the Surveillance, Epidemiology, and End Results Registry
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Management and outcomes of patients with invasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas are not well established. We investigated whether adjuvant radiotherapy (RT) improved cancer-specific survival (CSS) and overall survival (OS) among patients undergoing surgical resection for invasive IPMN.
The Surveillance, Epidemiology, and End Results (SEER) registry was used in this retrospective cohort study. All adult patients with resection of invasive IPMN from 1988 to 2007 were included. CSS and OS were analyzed using Kaplan–Meier curves. Unadjusted and propensity-score-adjusted Cox proportional-hazards modeling were used for subgroup analyses.
972 patients were included. Adjuvant RT was administered to 31.8% (n = 309) of patients. There was no difference in overall median CSS or OS in patients who received adjuvant RT (5-year CSS: 26.5 months; 5-year OS: 23.5 months) versus those who did not (CSS: 28.5 months, P = 0.17; OS: 23.5 months, P = 0.23). Univariate predictors of survival were lymph node (LN) involvement, T4-classified tumors, and poorly differentiated tumor grade (all P < 0.05). In the propensity-score-adjusted analysis, adjuvant RT was associated with improved 5-year CSS [hazard ratio (HR): 0.67, P = 0.004] and 5-year OS (HR: 0.73, P = 0.014) among all patients with LN involvement, though further analysis by T-classification demonstrated no survival differences among patients with T1/T2 disease; patients with T3/T4-classified tumors had improved CSS (HR: 0.71, P = 0.022) but no difference in OS (HR: 0.76, P = 0.06).
On propensity-score-adjusted analysis, adjuvant RT was associated with improved survival in selected subsets of patients with invasive IPMN, particularly those with T3/T4 tumors and LN involvement.
KeywordsOverall Survival Propensity Score Intraductal Papillary Mucinous Neoplasm Propensity Score Adjustment Invasive Intraductal Papillary Mucinous Neoplasm
This work was supported by grant PBBEP3-131567 from the Swiss National Science Foundation (M.W.) and a health services research fellowship in the Penn Department of Radiation Oncology (A.S.). The authors have no other potential conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.
- 3.Kloppel G SE, Longnecker DS, et al. Histological typing of tumours of the exocrine pancreas. In: World Health Organization international classification of tumors. Berlin: Springer; 1996.Google Scholar
- 4.Longnecker DS AG, Hruban RH, Klöppel G. Intraductal papillary-mucinous neoplasms of the pancreas. In: Hamilton SR, Aaltonen LA, editors. WHO classification of tumours. Lyon, France: IARC Press; 2000. p. 237–40.Google Scholar
- 14.Wilentz RE, Hruban RH. Pathology of cancer of the pancreas. Surg Oncol Clin North Am. 1998;7:43–65.Google Scholar
- 17.Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Gastrointestinal Tumor Study Group. Cancer. 1987;59:2006–10.Google Scholar
- 19.Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985;120:899–903.Google Scholar
- 20.Klinkenbijl JH, Jeekel J, Sahmoud T, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg. 1999;230:776–82; discussion 782–4.PubMedCrossRefGoogle Scholar
- 25.http://www.seer.cancer.gov. Accessed 10 Aug 2011.
- 26.http://seer.cancer.gov/seerstat/. Accessed 10 Aug 2011.
- 27.Tomlinson JS, Jain S, Bentrem DJ, et al. Accuracy of staging node-negative pancreas cancer: a potential quality measure. Arch Surg. 2007;142:767–73; discussion 773–4.Google Scholar
- 28.Greene FL PD, Fleming ID, et al. AJCC cancer staging handbook. Chicago, IL: Springer; 2002.Google Scholar
- 39.Yopp AC, Katabi N, Janakos M, et al. Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas: a matched control study with conventional pancreatic ductal adenocarcinoma. Ann Surg. 2011.Google Scholar