Analysis of Fluorouracil-Based Adjuvant Chemotherapy and Radiation After Pancreaticoduodenectomy for Ductal Adenocarcinoma of the Pancreas: Results of a Large, Prospectively Collected Database at the Johns Hopkins Hospital

作者：Joseph M. Herman, Michael J. Swartz, Charles Chia-chuen Hsu, Jordan Michael Winter, Timothy Michael Pawlik, Elizabeth A. Sugar, Ray Robinson, Daniel A. Laheru, Elizabeth M. Jaffee, Ralph H. Hruban, Kurtis A. Campbell, Christopher Lee Wolfgang, Fariba Asrari, Ross C. Donehower, Manuel M. Hidalgo, Luis Alberto Diaz, Charles J. Yeo, John L. Cameron, Richard David Schulick, Ross Allen Abrams · 发表于：Journal of Clinical Oncology · 年份：2008 · DOI：10.1200/jco.2007.15.8469 · 被引用次数：376 · 研究领域：Pancreatic and Hepatic Oncology Research、Cholangiocarcinoma and Gallbladder Cancer Studies、Neuroendocrine Tumor Research Advances

PURPOSE: To examine the efficacy of adjuvant chemoradiotherapy after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC) in patients undergoing resection at Johns Hopkins Hospital (JHH; Baltimore, MD). PATIENTS AND METHODS: Between August 30, 1993, and February 28, 2005, a total of 908 patients underwent PD for PC at JHH. A prospective database was reviewed to determine which patients received fluorouracil (FU) -based CRT. Excluded patients had metastatic disease, died 60 or fewer days after PD, received preoperative therapy, an experimental vaccine, adjuvant chemotherapy or radiation alone. The final cohort includes 616 patients. RESULTS: The median follow-up was 17.8 months (interquartile range, 9.7 to 33.5 months). Overall median survival was 17.9 months (95% CI, 16.3 to 19.5 months). Groups were similar with respect to tumor size, nodal status, and margin status, but the CRT group was younger (P < .001), and less likely to present with a severe comorbid disease (P = .001). Patients with carcinomas larger than 3 cm (P = .001), grade 3 and 4 (P < .001), margin-positive resection (P = .001), and complications after surgery (P = .017) had poor long-term survival. Patients receiving CRT experienced an improved median (21.2 v 14.4 months; P < .001), 2-year (43.9% v 31.9%), and 5-year (20.1% v 15.4%) survival compared with no CRT. After controlling for high-risk features, CRT was still associated with improved survival (relative risk = 0.74; 95% CI, 0.62 to 0.89). CO...