- Design
- Retrospective propensity-score-matched cohort, two referral centres
- Population
- 452 matched patients with resected pancreatic adenocarcinoma after neoadjuvant chemotherapy
- Primary outcome
- Event-free survival, recurrence pattern and overall survival
- Effect
- Event-free survival HR 1.10 (95% CI 0.88 to 1.37); overall survival HR 1.02 (0.79 to 1.32)
A retrospective propensity-matched cohort from two referral centres included 800 patients who had pancreatectomy after neoadjuvant chemotherapy for pancreatic adenocarcinoma. After matching, 226 patients per group were compared, with or without preoperative radiotherapy.
Radiotherapy was linked to more node-negative disease (61.5% vs 33.6%) and R0 resection (85.0% vs 52.2%), and a pathologic complete response in 6.6% against 4.4%. Locoregional recurrence did not differ (subdistribution HR 0.90, 95% CI 0.53 to 1.54), and neither did event-free survival (HR 1.10, 0.88 to 1.37) or overall survival (HR 1.02, 0.79 to 1.32).
The pathology gains did not carry through to survival, which fits a disease dominated by distant recurrence. Retrospective matching cannot remove all selection bias. It supports caution about assuming that better margins mean longer survival, not a change in protocol on its own.
- Do not read a higher R0 rate as proof of survival benefit; it was not seen here.
- Distant recurrence was the first site of failure in about half of patients in both groups.
- Take the question of radiotherapy to the multidisciplinary meeting with this caveat.
- Randomised data remain the standard for deciding protocol changes.
Why it matters
It separates pathologic response from survival, two things often assumed to move together.
Don't overread it
This is a retrospective two-centre cohort; matching cannot rule out selection effects.
The statistics, in plain English
A hazard ratio close to 1 with an interval spanning 0.8 to 1.4 means the data are compatible with a small benefit or a small harm. Matching balances measured characteristics only, so unmeasured differences between who received radiotherapy may remain.
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