Survival effects of adjuvant chemoradiotherapy after resection for pancreatic carcinoma.

BACKGROUND The survival benefit of adjuvant chemotherapy alone or chemoradiotherapy in patients with pancreatic cancer who have undergone surgical resection remains unclear. OBJECTIVE To identify the additional benefit of adjuvant therapy by retrospectively examining a large population-based registry of patients who underwent definitive surgical resection for pancreatic adenocarcinoma. DESIGN AND SETTING The Florida cancer registry and state inpatient and outpatient hospital data records were queried for pancreatic adenocarcinoma diagnosed between 1998 and 2002. PATIENTS A total of 2877 patients who underwent surgical resection with curative intent for pancreatic adenocarcinoma were identified. Main Outcome Measure Overall survival time. RESULTS Overall, 58.7% of patients were older than 65 years. Most patients were white (90.7%), were non-Hispanic (86.7%), and did not consume alcohol abusively (89.2%). Approximately half of the patients (51.9%) did not receive chemotherapy or chemoradiotherapy. Approximately 25.0% of the patients underwent chemoradiotherapy, and 10.0% received chemotherapy alone. Patients were more frequently treated at low-volume centers (57.6%) and nonteaching facilities (72.8%). Multivariate analysis correcting for patient comorbidities demonstrated that postoperative chemoradiotherapy (hazard ratio = 0.69, P = .04) and treatment at high-volume centers (hazard ratio = 0.85, P < .001) and teaching facilities (hazard ratio = 0.84, P < .001) were independent predictors of improved survival. CONCLUSIONS Adjuvant chemoradiotherapy was found to provide a significant additional survival benefit to surgical resection for patients with pancreatic adenocarcinoma. Furthermore, this benefit is independent of the additional survival advantage when patients are treated at teaching facilities or high-volume centers. Although selection bias may be contributing to the observed differences, these data nonetheless support the use of adjuvant chemoradiotherapy for pancreatic cancer.