Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3634–3642 | Cite as

Impact of Adjuvant Radiotherapy on Survival after Pancreatic Cancer Resection: An Appraisal of Data from the National Cancer Data Base

  • David A. KoobyEmail author
  • Theresa W. Gillespie
  • Yuan Liu
  • Johnita Byrd-Sellers
  • Jerome Landry
  • John Bian
  • Joseph Lipscomb
Pancreatic Tumors



The impact of adjuvant radiotherapy for pancreatic adenocarcinoma (PAC) remains controversial. We examined effects of adjuvant therapy on overall survival (OS) in PAC, using the National Cancer Data Base (NCDB).


Patients with resected PAC from 1998 to 2002 were queried from the NCDB. Factors associated with receipt of adjuvant chemotherapy (ChemoOnly) versus adjuvant chemoradiotherapy (ChemoRad) versus no adjuvant treatment (NoAdjuvant) were assessed. Cox proportional hazard modeling was used to examine effect of adjuvant therapy type on OS. Propensity scores (PS) were developed for each treatment arm and used to produce matched samples for analysis to minimize selection bias.


From 1998 to 2002, a total of 11,526 patients underwent resection of PAC. Of these, 1,029 (8.9 %) received ChemoOnly, 5,292 (45.9 %) received ChemoRad, and 5,205 (45.2 %) received NoAdjuvant. On univariate analysis, factors associated with improved OS included: younger age, higher income, higher facility volume, lower tumor stage and grade, negative margins and nodes, and absence of adjuvant therapy. On multivariate analysis with matched PS, factors independently associated with improved OS included: younger age, higher income, higher facility volume, later year of diagnosis, smaller tumor size, lower tumor stage, and negative tumor margins and nodes. ChemoRad had the best OS (hazard ratio 0.70, 95 % confidence interval 0.61–0.80) in a PS matched comparison with ChemoOnly (hazard ratio 1.04, 95 % confidence interval 0.93–1.18) and NoAdjuvant (index).


Adjuvant chemotherapy with radiotherapy is associated with improved OS after PAC resection in a large population from the NCDB. On the basis of these analyses, radiotherapy should be a part of adjuvant therapy for PAC.


Overall Survival Gemcitabine Adjuvant Therapy Propensity Score Good Overall Survival 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Supported in part by grant 5P30CA138292 from the National Cancer Institute.



Supplementary material

10434_2013_3047_MOESM1_ESM.docx (250 kb)
Supplementary material 1 (DOCX 249 kb)


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • David A. Kooby
    • 1
    • 2
    • 3
    Email author
  • Theresa W. Gillespie
    • 1
    • 2
    • 3
  • Yuan Liu
    • 3
    • 4
  • Johnita Byrd-Sellers
    • 2
  • Jerome Landry
    • 3
    • 5
  • John Bian
    • 6
  • Joseph Lipscomb
    • 3
    • 7
  1. 1.Department of SurgeryEmory University School of MedicineAtlantaUSA
  2. 2.Atlanta Veterans Affairs Medical CenterDecaturUSA
  3. 3.Winship Cancer Institute of Emory UniversityAtlantaUSA
  4. 4.Department of Biostatistics and Bioinformation, Rollins School of Public HealthEmory UniversityAtlantaUSA
  5. 5.Department of Radiation OncologyEmory University School of MedicineAtlantaUSA
  6. 6.Department of Clinical Pharmacy and Outcomes SciencesUniversity of South CarolinaCharlestonUSA
  7. 7.Department of Health Policy and ManagementRollins School of Public Health, Emory UniversityAtlantaUSA

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