Stage IA Patients With Pancreatic Ductal Adenocarcinoma Cannot Benefit From Chemotherapy: A Propensity Score Matching Study

Abstract

Purpose: Adjuvant chemotherapy following resection is recommended by clinical practice guidelines for all patients with pancreatic ductal adenocarcinoma (PDAC). This study aimed to evaluate the efficacy of adjuvant chemotherapy among the staging groups of the American Joint Committee on Cancer (AJCC) for PDAC. Patients and Methods: This retrospective cohort analysis was performed by the Surveillance Epidemiology and End Results (SEER) (2004-2015) database and multi-institutional dataset (2010-2018). Baseline clinicopathologic characteristics of PDAC patients, including age, gender, ethnicity, marital status, education level, county income level, county unemployed rate, insurance status, grade, stage, chemotherapy, and radiotherapy, were collected. Overall survival (OS) was analyzed using the Kaplan-Meier method. The SEER and multi-institutional data were adjusted with 1:1 ratio propensity score matching (PSM). Results: In total, 6,274 and 1,361 PDAC patients were included from the SEER database and multi-institutional dataset, respectively. Regardless of the count of resected lymph nodes, adjuvant chemotherapy prolonged the long-term OS time for stage IB, IIA, IIB, and III patients in both SEER and multi-institutional cohorts. Nevertheless, adjuvant chemotherapy did not provide additional clinical benefits even after a PSM adjustment for stage IA patients in both SEER and multi-institutional cohorts. Conclusion: Adjuvant chemotherapy improved the long-term survival of stage IB, IIA, IIB, and III PDAC patients; however, it demonstrated no survival benefit in stage IA PDAC patients. Thus, adjuvant chemotherapy should not be recommended for stage IA PDAC patients. These would significantly reduce the economic burden of society and improve the life quality of stage IA PDAC patients.

Keywords: End Results (SEER); Epidemiology; Surveillance; chemotherapy; overall survival; pancreatic ductal adenocarcinoma; prognosis.

Figure 1

Overall survival (OS) curves for pancreatic ductal adenocarcinoma (PDAC) patients with different stages from the Surveillance, Epidemiology, and End Results (SEER) database according to the 8th American Joint Committee on Cancer (AJCC) staging system. Stage IA with 15 or more resected lymph nodes (A); stage IA with <15 resected lymph nodes (B); stage IB with 15 or more resected lymph nodes (C); stage IB with <15 resected lymph nodes (D); stage IIA with 15 or more resected lymph nodes (E); stage IIA with <15 resected lymph nodes (F); stage IIB with 15 or more resected lymph nodes (G); stage IIB with <15 resected lymph nodes (H); stage III with 15 or more resected lymph nodes (I); stage III with <15 resected lymph nodes (J).

Figure 2

Overall survival (OS) curves for stage IA pancreatic ductal adenocarcinoma (PDAC) patients from the Surveillance, Epidemiology, and End Results (SEER), and multi-institutional dataset after propensity score matching (PSM) adjustment. Stage IA with 15 or more resected lymph nodes from the SEER database (A); stage IA with <15 resected lymph nodes from the SEER database (B); stage IA with 15 or more resected lymph nodes from the multi-institutional dataset (C); stage IA with <15 resected lymph nodes from the multi-institutional dataset (D).

Figure 3

Overall survival (OS) curves for pancreatic ductal adenocarcinoma (PDAC) patients with different stages from the multi-institutional dataset according to the 8th American Joint Committee on Cancer (AJCC) staging system. Stage IA with 15 or more resected lymph nodes (A); stage IA with <15 resected lymph nodes (B); stage IB with 15 or more resected lymph nodes (C); stage IB with <15 resected lymph nodes (D); stage IIA with 15 or more resected lymph nodes (E); stage IIA with <15 resected lymph nodes (F); stage IIB with 15 or more resected lymph nodes (G); stage IIB with <15 resected lymph nodes (H); stage III with 15 or more resected lymph nodes (I); stage III with <15 resected lymph nodes (J).