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Annals of Surgical Oncology

, Volume 19, Issue 4, pp 1316–1323 | Cite as

Adjuvant Radiotherapy in the Treatment of Invasive Intraductal Papillary Mucinous Neoplasm of the Pancreas: an Analysis of the Surveillance, Epidemiology, and End Results Registry

  • Mathias Worni
  • Igor Akushevich
  • Beat Gloor
  • John Scarborough
  • Junzo P. Chino
  • Danny O. Jacobs
  • Stephen M. Hahn
  • Bryan M. Clary
  • Ricardo Pietrobon
  • Anand Shah
Pancreatic Tumors

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Overall Survival Propensity Score Intraductal Papillary Mucinous Neoplasm Propensity Score Adjustment Invasive Intraductal Papillary Mucinous Neoplasm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

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.

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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Mathias Worni
    • 1
    • 2
  • Igor Akushevich
    • 3
  • Beat Gloor
    • 2
  • John Scarborough
    • 4
  • Junzo P. Chino
    • 5
  • Danny O. Jacobs
    • 4
  • Stephen M. Hahn
    • 6
  • Bryan M. Clary
    • 4
  • Ricardo Pietrobon
    • 1
  • Anand Shah
    • 6
  1. 1.Research on Research, Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Department of Visceral Surgery and MedicineUniversity of BernBernSwitzerland
  3. 3.Center for Population Health and AgingDuke UniversityDurhamUSA
  4. 4.Department of SurgeryDuke University Medical CenterDurhamUSA
  5. 5.Department of Radiation OncologyDuke University Medical CenterDurhamUSA
  6. 6.Department of Radiation OncologyHospital of the University of PennsylvaniaPhiladelphiaUSA

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