Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 15;15(1):155-170.
doi: 10.4251/wjgo.v15.i1.155.

Survival benefits and disparities in radiation therapy for elderly patients with pancreatic ductal adenocarcinoma

Bi-Yang Cao  1   2 , Qian-Qian Wang  1 , Le-Tian Zhang  1   2 , Chen-Chen Wu  1   2 , Fang Tong  1 , Wei Yang  1 , Jing Wang  3
Affiliations

Survival benefits and disparities in radiation therapy for elderly patients with pancreatic ductal adenocarcinoma

Bi-Yang Cao et al. World J Gastrointest Oncol. .

Abstract

Background: Older patients represent a unique subgroup of the cancer patient population, for which the role of cancer therapy requires special consideration. However, the outcomes of radiation therapy (RT) in elderly patients with pancreatic ductal adenocarcinoma (PDAC) are not well-defined in the literature.

Aim: To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice.

Methods: Data from patients with PDAC aged ≥ 65 years between 2004 and 2018 were collected from the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression analysis was performed to determine factors associated with RT administration. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using the Kaplan-Meier method with the log-rank test. Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS. Propensity score matching (PSM) was applied to balance the baseline characteristics between the RT and non-RT groups. Subgroup analyses were performed based on clinical characteristics.

Results: A total of 12245 patients met the inclusion criteria, of whom 2551 (20.8%) were treated with RT and 9694 (79.2%) were not. The odds of receiving RT increased with younger age, diagnosis in an earlier period, primary site in the head, localized disease, greater tumor size, and receiving chemotherapy (all P < 0.05). Before PSM, the RT group had better outcomes than did the non-RT group [median OS, 14.0 vs 6.0 mo; hazard ratio (HR) for OS: 0.862, 95% confidence interval (CI): 0.819-0.908, P < 0.001; and HR for CSS: 0.867, 95%CI: 0.823-0.914, P < 0.001]. After PSM, the survival benefit associated with RT remained comparable (median OS: 14.0 vs 11.0 mo; HR for OS: 0.818, 95%CI: 0.768-0.872, P < 0.001; and HR for CSS: 0.816, 95%CI: 0.765-0.871, P < 0.001). Subgroup analysis revealed that the survival benefits (OS and CSS) of RT were more significant in patients aged 65 to 80 years, in regional and distant stages, with no surgery, and receiving chemotherapy.

Conclusion: RT improved the outcome of elderly patients with PDAC, particularly those aged 65 to 80 years, in regional and distant stages, with no surgery, and who received chemotherapy. Further prospective studies are warranted to validate our results.

Keywords: Disparities; Effectiveness; Elderly; Pancreatic ductal adenocarcinoma; Radiotherapy; Surveillance, Epidemiology, and End Results.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flow chart of study enrollment and exclusions. SEER: Surveillance, Epidemiology, and End Results; PDAC: Pancreatic ductal adenocarcinoma; ICD-O-3: International Classification of Diseases for Oncology, Third Edition; RT: Radiation therapy.
Figure 2
Figure 2
Kaplan–Meier curves for overall survival and cancer-specific survival of radiation therapy in elderly patients with pancreatic ductal adenocarcinoma before propensity score matching. A: Kaplan–Meier curve of overall survival; B: Kaplan–Meier curve of cancer-specific survival; OS: Overall survival; CSS: Cancer-specific survival; PSM: Propensity score matching.
Figure 3
Figure 3
Kaplan–Meier curves for overall survival and cancer-specific survival of radiation therapy in elderly patients with pancreatic ductal adenocarcinoma after propensity score matching. A: Kaplan–Meier curve of overall survival; B: Kaplan–Meier curve of cancer-specific survival; OS: Overall survival; CSS: Cancer-specific survival; PSM: Propensity score matching.
Figure 4
Figure 4
Subgroup analysis of radiation therapy or non-radiation therapy for overall survival in elderly patients with pancreatic ductal adenocarcinoma after propensity score matching. SEER: Surveillance, Epidemiology, and End Results; HR: Hazard ratio; RT: Radiation therapy; CI: Confidence interval.
Figure 5
Figure 5
Subgroup analysis of radiation therapy or non-radiation therapy for cancer-specific survival in elderly patients with pancreatic ductal adenocarcinoma after propensity score matching. SEER: Surveillance, Epidemiology, and End Results; HR: Hazard ratio; RT: Radiation therapy; CI: Confidence interval.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209–249. - PubMed
    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–E386. - PubMed
    1. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–2765. - PubMed
    1. Strobel O, Neoptolemos J, Jäger D, Büchler MW. Optimizing the outcomes of pancreatic cancer surgery. Nat Rev Clin Oncol. 2019;16:11–26. - PubMed
    1. Tempero MA, Behrman S, Ben-Josef E, Benson AB 3rd, Cameron JL, Casper ES, Hoffman JP, Karl RC, Kim P, Koh WJ, Kuvshinoff BW 2nd, Melvin WS, Muscarella P 2nd, Sasson AR, Shibata S, Shrieve DC, Talamonti MS, Tyler DS, Vickers SM, Warren RS, Willett C, Wolff RA National Comprehensive Cancer Network. Pancreatic adenocarcinoma: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2005;3:598–626. - PubMed