Survival outcomes in patients with early stage, resected pancreatic cancer-a comparison of gemcitabine-and 5-fluorouracil-based chemotherapy and chemoradiation regimens

• Type of Material: Article
• Authors: Sani H. Kizilbash, William Beaumont Hospital; Kevin C. Ward, Emory University; Jackson J. Liang, Mayo Clinic; Ishmael Jaiyesimi, William Beaumont Hospital; Joseph Lipscomb, Emory University
• Language: English
• Date: 2014-05-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 John Wiley & Sons Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1111/ijcp.12353
• Title of Journal or Parent Work: International Journal of Clinical Practice
• ISSN: 1368-5031
• Volume: 68
• Issue: 5
• Start Page: 578
• End Page: 589
• Grant/Funding Information: This work was supported by the Metropolitan Atlanta SEER Registry under National Cancer Institute (NCI) contract N01-PC-35135 with Emory University.
• Keywords: PERIAMPULLARY REGION; Life Sciences & Biomedicine; General & Internal Medicine; Pharmacology & Pharmacy; Medicine, General & Internal; CHEMORADIOTHERAPY; PHASE-III TRIAL; CURATIVE RESECTION; Science & Technology; FLUOROURACIL; FOLINIC ACID; COOPERATIVE GROUP; ADJUVANT CHEMOTHERAPY; RANDOMIZED CONTROLLED-TRIAL; COMORBIDITY INDEX
• Research Categories: Health Sciences, Oncology; Health Sciences, Epidemiology; Health Sciences, Health Care Management

Abstract

Purpose: We conducted a comparative survival analysis between patients with resected pancreatic cancer who received adjuvant treatment with either gemcitabine- or 5-fluorouracil-based chemotherapy and chemoradiation regimens. Patients and methods: The Surveillance, Epidemiology and End Results (SEER)-Medicare database was used to identify patients with pancreatic cancer diagnosed from 1998 to 2005 who received curative surgery and adjuvant chemotherapy with either 5-fluorouracil or gemcitabine. These groups were subdivided by treatment with radiotherapy. Patients were followed until death, study end-point or a maximum of 5 years after diagnosis. Results: Three hundred and fifty-nine patients received 5-fluorouracil and 346 received gemcitabine. Compared with chemoradiation with 5-fluorouracil, outcomes for patients who received chemoradiation with gemcitabine did not differ. Patients who received gemcitabine without radiation had increased hazards (poorly differentiated tumours: HR = 1.50, p = 0.01; moderately differentiated tumours, HR = 1.28, p = 0.11). However, outcomes of patients who received 5-fluorouracil without radiation varied with tumour grade. In moderately differentiated tumours, patients had better outcomes with 5-fluorouracil when compared with chemoradiation with 5-fluorouracil (HR = 0.42, p = 0.02). In poorly differentiated tumours, the opposite was true (HR 2.10, p = 0.09). Conclusion: Patients with low-grade resected pancreatic cancer may have better outcomes with 5-fluorouracil-based chemotherapy without radiation when compared with 5-fluorouracil with radiation.