The efficacy of adjuvant therapy for pancreatic invasive @entity4929 ( XXXX ).

@entity1 @entity4929 @entity1124 @entity5 @entity1349
BACKGROUND: The literature investigating pancreatic invasive @entity4929 ( @entity4929 ) has largely come from small institutional studies, preventing adequately powered comparisons of adjuvant therapy versus surgery alone (SA) within specific @entity1 subgroups. METHODS: @entity1 with resected, stage I through IV, invasive @entity4929 and conventional @entity1124 ( @entity1124 ) were identified in the National @entity5 Data Base (1998-2010). Cox modeling of @entity1 with invasive @entity4929 was used to compare @entity1349 ( @entity1349 ) between @entity1 who received adjuvant therapy and those who underwent SA. A second model was used to compare @entity1349 between @entity1 with invasive @entity4929 and those with @entity1124 . RESULTS: For the 1220 @entity1 with invasive @entity4929 , the median @entity1349 was 28.9 months; the 1-year and 5-year actuarial survival rates were 76% and 17%, respectively; and 47% received adjuvant therapy. Cox modeling associated SA with worse @entity1349 (hazard ratio, 1.36; 95% confidence interval, 1.17-1.58; P   =   .00005) as well as American Joint Committee on @entity5 (AJCC) TNM stage III/IV disease, positive lymph node status, positive margins, and poor @entity5 differentiation (all P    <=   .05). In addition, Cox modeling stratified by the following characteristics demonstrated improved @entity1349 with adjuvant therapy: AJCC TNM stage II or III/IV, positive lymph node status, positive margins, and poorly differentiated @entity5 . There was no survival advantage from adjuvant therapy for @entity1 who had AJCC TNM stage I or lymph node-negative disease. @entity1 who had invasive @entity4929 had improved risk-adjusted @entity1349 compared with those who had @entity1124 (hazard ratio, 0.73; 95% confidence interval, 0.68-0.78; P   <   .00001). CONCLUSIONS: Invasive @entity4929 appears to be more indolent than conventional @entity1124 . Adjuvant therapy is associated with improved @entity1349 compared with SA in @entity1 with invasive @entity4929 , especially for those with higher stage disease, positive lymph nodes, positive margins, or poorly differentiated @entity5 . Conversely, this benefit does not extend to @entity1 with stage I or lymph node-negative disease. @entity5 2016;122:521-533.    2015 American @entity5 Society.
