Comparison of Adjuvant Chemotherapy and Chemoradiation Therapy Efficacy for Pancreatic Cancer After R0 Resection: A Propensity Score-Matched Analysis

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Abstract Background Adjuvant therapy is a standard treatment for resected pancreatic cancer, and a variety of regimens are now used in clinical practice. We aimed to compare the efficacy of adjuvant chemotherapy and chemoradiation therapy in R0 resected pancreatic cancer. Methods Patients who underwent complete microscopic resection and subsequent adjuvant treatment for pancreatic ductal adenocarcinoma (N=277) at Seoul National University Hospital from September 2005 to December 2017 were retrospectively included. Patients were divided into two groups; systemic chemotherapy (SCT) and combined chemotherapy plus chemoradiation therapy (SCT-CRT). The primary outcomes were differences in overall survival (OS) between the two groups. Survival differences were compared using the log-rank test. Patients receiving either SCT or SCT-CRT were matched 1:1 on the propensity scores. Results Patients received SCT (n=78) and SCT-CRT (n=199). There was no significant difference in completion rate of planned regimens between the two groups (73.1% and 76.9%, respectively; P=0.534). In the propensity score-matched cohort, there was no significant difference in the median OS between the SCT and SCT-CRT groups (35.1 [95% CI, 26.9-82.1] months and 34.8 [95% CI, 26.2-69.2] months, respectively; P=0.993). The median RFS was 15.4 (95% CI, 12.1-31.1) months in the SCT group and 17.0 (95% CI, 13.2-37.3) months in SCT-CRT group (P=0.789). There were no significant differences in the incidence of loco-regional and distant recurrence between the two groups (P=0.833 and P=0.491, respectively). Adverse events greater than or equal to moderate grade occurred more frequently in the SCT-CRT group than in the SCT group (P=0.042). Conclusion Considering its efficacy and safety, adjuvant SCT alone might be a reasonable choice over SCT-CRT in R0 resected pancreatic cancer.

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