Abstract
Amaç: Çalışmanın amacı radyoterapi (RT) alan pankreas kanserli hastalarda sağkalım sonuçları ile prognoza etki eden faktörleri araştırmaktır.
Gereç ve Yöntem: Toplamda 73 pankreas kanseri olan ve 2013-2021 yılları arasında RT almış olan hastalar çalışmaya dahil edildi. Hastaların klinik, demografik ve histopatolojik özellikleri ile RT amacı (adjuvan, definitif, neoadjuvan veya palyatif) kaydedildi.
Bulgular: Hastaların medyan yaşı 62 (37-78) idi. Erkek/kadın oranı 1.6 idi. Medyan genel sağkalım adjuvan RT alanlarda (n=52) 25.7 ay (11.6-39.7 ay), definitif RT alanlarda (n=13) 16 ay (7-67 ay) ve palyatif RT alanlarda (n=7) 9 ay (5-52 ay) idi. Neoadjuvan RT alan 1 hastada medya sağkalım süresi 26.6 aydı. Lenf nodu oranı (LNO) ile genel sağkalım arasında anlamlı bir ilişki bulundu. LNO >0.4 olan hastalarn genel sağkalımı LNO ≤0.4 olanlara göre daha kötüydü (p=0.003). Dahası adjuvan RT alan ve LNO ≤0.4 hastalarda çalışmadaki geri kalan hastalara kıyasla daha iyi genel sağkalım tespit edildi. (12.1 aya karşın 7.7 ay, p=0.001). Tümör büyüklüğü tek değişkenli analizde kötü sağkalım ile ilişkili bulundu (p=0.04), ancak, çok değişkenli analizde sağkalımın sadece LNO tarafınca anlamlı oranda bulundu (p=0.01). Diğer faktörlerle sağkalım arasında anlamlı bir ilişki bulunamadı.
Sonuç: Radyoterapi alan hastalarda LNO ile genel sağkalım arasında güçlü bir ilişki vardı. Ayrıca küçük LNO olan ve adjuvan RT alan hastalarda sağkalım daha iyiydi.
References
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin 2021; 71: 7-33.
- Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet 2011; 378: 607-20.
- Heinen MM, Verhage BA, Goldbohm RA, van den Brandt PA. Active and passive smoking and the risk of pancreatic cancer in the Netherlands Cohort Study. Cancer Epidemiol Biomarkers Prev 2010; 19: 1612-22.
- Eijgenraam P, Heinen MM, Verhage BA, Keulemans YC, Schouten LJ, van den Brandt PA. Diabetes type II, other medical conditions and pancreatic cancer risk: a prospective study in The Netherlands. Br J Cancer 2013; 109: 2924-32.
- Fitzpatrick SG, Katz J. The association between periodontal disease and cancer: a review of the literature. J Dent 2010; 38: 83-95.
- Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol 2009; 6: 699-708.
- Lucenteforte E, La Vecchia C, Silverman D, et al. Alcohol consumption and pancreatic cancer: a pooled analysis in the International Pancreatic Cancer Case-Control Consortium (PanC4). Ann Oncol 2012; 23: 374-82.
- Govindarajan A, Tan JC, Baxter NN, Coburn NG, Law CH. Variations in surgical treatment and outcomes of patients with pancreatic cancer: a population-based study. Ann Surg Oncol 2008; 15: 175-85.
- Baxter NN, Whitson BA, Tuttle TM. Trends in the treatment and outcome of pancreatic cancer in the United States. Ann Surg Oncol 2007; 14: 1320-6.
- Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007; 297: 267-77.
- Abrams RA, Lowy AM, O'Reilly EM, Wolff RA, Picozzi VJ, Pisters PW. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 2009; 16: 1751-6.
- Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002; 236: 355-66.
- Yeo CJ, Abrams RA, Grochow LB, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 1997; 225: 621-33.
- Pawlik TM, Gleisner AL, Cameron JL, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery 2007; 141: 610-8.
- Pantalone D, Ragionieri I, Nesi G. Improved survival in small pancreatic cancer. Dig Surg 2001; 18: 41-6.
- 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.
- Hsu CC, Herman JM, Corsini MM, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol 2010; 17: 981-90.
- Herman JM, Swartz MJ, Hsu CC, et al. 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. J Clin Oncol 2008; 26: 3503-10.
- Corsini MM, Miller RC, Haddock MG, et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975-2005). J Clin Oncol 2008; 26: 3511-6.
- Versteijne E, Suker M, Groothuis K, et al. Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial. J Clin Oncol 2020; 38: 1763-73.
- Huguet F, Andre T, Hammel P, et al. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 2007; 25: 326-31.
- Shinchi H, Takao S, Noma H, et al. Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 2002; 53: 146-50.
- Li CP, Chao Y, Chi KH, et al. Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys 2003; 57: 98-104.
- Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist 2007; 12: 20-37.
- Huang Z, Liu F. Diagnostic value of serum carbohydrate antigen 19-9 in pancreatic cancer: a meta-analysis. Tumour Biol 2014; 35: 7459-65.
- Chang DK, Johns AL, Merrett ND, et al. Margin clearance and outcome in resected pancreatic cancer. J Clin Oncol 2009; 27: 2855-62.
- Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004; 91: 586-94.
- Herman JM, Moreno AC, Crane CH, Iacobuzio-Donahue CA, Abrams RA. Pancreatic Cancer. In: Joel ET, Robert LF, Jeff MM, editors. Gunderson & Tepper's Clinical Radiation Oncology. 5th ed. Philadelphia: Elsevier; 2021. p. 946-72.
- Asiyanbola B, Gleisner A, Herman JM, et al. Determining pattern of recurrence following pancreaticoduodenectomy and adjuvant 5-flurouracil-based chemoradiation therapy: effect of number of metastatic lymph nodes and lymph node ratio. J Gastrointest Surg 2009; 13: 752-9.
- Pongprasobchai S, Pannala R, Smyrk TC, et al. Long-term survival and prognostic indicators in small (<or=2 cm) pancreatic cancer. Pancreatology 2008; 8: 587-92.
Prognostic factors for survival in pancreatic cancer patients received radiotherapy: a single-center experience
Abstract
Aim: To investigate survival outcomes and factors affecting the prognosis of patients with pancreatic cancer (PC) who received radiotherapy (RT).
Material and Method: A total of 73 patients with PC who received RT between 2013 and 2021 were included in the study. Clinical, demographic, and histopathological features of the patients, and the goal of RT (adjuvant, definitive, neoadjuvant, or palliative) were recorded.
Results: Median age of the patients was 62 (37-78). Male to female ratio was 1.6. In patients treated with adjuvant (n=52), definitive (n=13), and palliative (n=7) RT, median overall survival (OS) was 25.7 (11.6-39.7), 16 (7-67), and 9 (5-52) months, respectively. Survival time of 1 patient who received neoadjuvant RT was 26.6 months. Lymph node ratio (LNR) was significantly associated with OS. Patients with LNR ≤0.4 had better survival compared to those with LNR >0.4 (p=0.003). Furthermore, patients with LNR ≤0.4 and received adjuvant RT survived longer than the rest of the patients (12.1 vs. 7.7 months, p=0.001). Larger tumors (p=0.04) and LNR (p=0.003) were associated with poorer survival in univariate analysis, however, in the multivariate analysis, OS was found significantly affected only by LNR (p=0.01). Other factors were not found associated with survival.
Conclusion: LNR had a strong correlation with OS in PC patients treated with radiation. Smaller LNR was associated with better survival in patients who received RT in the adjuvant setting.
References
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin 2021; 71: 7-33.
- Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet 2011; 378: 607-20.
- Heinen MM, Verhage BA, Goldbohm RA, van den Brandt PA. Active and passive smoking and the risk of pancreatic cancer in the Netherlands Cohort Study. Cancer Epidemiol Biomarkers Prev 2010; 19: 1612-22.
- Eijgenraam P, Heinen MM, Verhage BA, Keulemans YC, Schouten LJ, van den Brandt PA. Diabetes type II, other medical conditions and pancreatic cancer risk: a prospective study in The Netherlands. Br J Cancer 2013; 109: 2924-32.
- Fitzpatrick SG, Katz J. The association between periodontal disease and cancer: a review of the literature. J Dent 2010; 38: 83-95.
- Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol 2009; 6: 699-708.
- Lucenteforte E, La Vecchia C, Silverman D, et al. Alcohol consumption and pancreatic cancer: a pooled analysis in the International Pancreatic Cancer Case-Control Consortium (PanC4). Ann Oncol 2012; 23: 374-82.
- Govindarajan A, Tan JC, Baxter NN, Coburn NG, Law CH. Variations in surgical treatment and outcomes of patients with pancreatic cancer: a population-based study. Ann Surg Oncol 2008; 15: 175-85.
- Baxter NN, Whitson BA, Tuttle TM. Trends in the treatment and outcome of pancreatic cancer in the United States. Ann Surg Oncol 2007; 14: 1320-6.
- Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007; 297: 267-77.
- Abrams RA, Lowy AM, O'Reilly EM, Wolff RA, Picozzi VJ, Pisters PW. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 2009; 16: 1751-6.
- Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002; 236: 355-66.
- Yeo CJ, Abrams RA, Grochow LB, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 1997; 225: 621-33.
- Pawlik TM, Gleisner AL, Cameron JL, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery 2007; 141: 610-8.
- Pantalone D, Ragionieri I, Nesi G. Improved survival in small pancreatic cancer. Dig Surg 2001; 18: 41-6.
- 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.
- Hsu CC, Herman JM, Corsini MM, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol 2010; 17: 981-90.
- Herman JM, Swartz MJ, Hsu CC, et al. 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. J Clin Oncol 2008; 26: 3503-10.
- Corsini MM, Miller RC, Haddock MG, et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975-2005). J Clin Oncol 2008; 26: 3511-6.
- Versteijne E, Suker M, Groothuis K, et al. Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial. J Clin Oncol 2020; 38: 1763-73.
- Huguet F, Andre T, Hammel P, et al. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 2007; 25: 326-31.
- Shinchi H, Takao S, Noma H, et al. Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 2002; 53: 146-50.
- Li CP, Chao Y, Chi KH, et al. Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys 2003; 57: 98-104.
- Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist 2007; 12: 20-37.
- Huang Z, Liu F. Diagnostic value of serum carbohydrate antigen 19-9 in pancreatic cancer: a meta-analysis. Tumour Biol 2014; 35: 7459-65.
- Chang DK, Johns AL, Merrett ND, et al. Margin clearance and outcome in resected pancreatic cancer. J Clin Oncol 2009; 27: 2855-62.
- Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004; 91: 586-94.
- Herman JM, Moreno AC, Crane CH, Iacobuzio-Donahue CA, Abrams RA. Pancreatic Cancer. In: Joel ET, Robert LF, Jeff MM, editors. Gunderson & Tepper's Clinical Radiation Oncology. 5th ed. Philadelphia: Elsevier; 2021. p. 946-72.
- Asiyanbola B, Gleisner A, Herman JM, et al. Determining pattern of recurrence following pancreaticoduodenectomy and adjuvant 5-flurouracil-based chemoradiation therapy: effect of number of metastatic lymph nodes and lymph node ratio. J Gastrointest Surg 2009; 13: 752-9.
- Pongprasobchai S, Pannala R, Smyrk TC, et al. Long-term survival and prognostic indicators in small (<or=2 cm) pancreatic cancer. Pancreatology 2008; 8: 587-92.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles [en] Araştırma Makaleleri [tr] |
| Authors | |
| Early Pub Date | October 24, 2022 |
| Publication Date | February 10, 2023 |
| Published in Issue | Year 2023 Volume: 4 Issue: 1 |
TR DİZİN ULAKBİM and International Indexes (1d)
Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]
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