Optimal Duration and Timing of Adjuvant Chemotherapy After Definitive Surgery for Ductal Adenocarcinoma of the Pancreas: Ongoing Lessons From the ESPAC-3 Study
Identifieur interne : 004032 ( Main/Exploration ); précédent : 004031; suivant : 004033Optimal Duration and Timing of Adjuvant Chemotherapy After Definitive Surgery for Ductal Adenocarcinoma of the Pancreas: Ongoing Lessons From the ESPAC-3 Study
Auteurs : Juan W. Valle [États-Unis] ; Daniel Palmer [Royaume-Uni] ; Richard Jackson [Royaume-Uni] ; Trevor Cox [Royaume-Uni] ; John P. Neoptolemos [Royaume-Uni] ; Paula Ghaneh [Royaume-Uni] ; Charlotte L. Rawcliffe [Royaume-Uni] ; Claudio Bassi [Italie] ; Deborah D. Stocken [Royaume-Uni] ; David Cunningham [Royaume-Uni] ; Derek O'Reilly [États-Unis] ; David Goldstein [Australie] ; Bridget A. Robinson [Australie] ; Christos Karapetis [Australie] ; Andrew Scarfe [Canada] ; Francois Lacaine [France] ; Juhani Sand [Finlande] ; Jakob R. Izbicki [Allemagne] ; Julia Mayerle [Allemagne] ; Christos Dervenis [Grèce] ; Attila Olah [Hongrie] ; Giovanni Butturini [Italie] ; Pehr A. Lind [Suède] ; Mark R. Middleton [États-Unis] ; Alan Anthoney [Royaume-Uni] ; Kate Sumpter [États-Unis] ; Ross Carter ; Markus W. Büchler [Allemagne]Source :
- Journal of clinical oncology [ 0732-183X ] ; 2014.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Chirurgie.
English descriptors
- KwdEn :
Abstract
Purpose Adjuvant chemotherapy improves patient survival rates after resection for pancreatic adenocarcinoma, but the optimal duration and time to initiate chemotherapy is unknown. Patients and Methods Patients with pancreatic ductal adenocarcinoma treated within the international, phase III, European Study Group for Pancreatic Cancer-3 (version 2) study were included if they had been randomly assigned to chemotherapy. Overall survival analysis was performed on an intention-to-treat basis, retaining patients in their randomized groups, and adjusting the overall treatment effect by known prognostic variables as well as the start time of chemotherapy. Results There were 985 patients, of whom 486 (49%) received gemcitabine and 499 (51%) received fluorouracil; 675 patients (68%) completed all six cycles of chemotherapy (full course) and 293 patients (30%) completed one to five cycles. Lymph node involvement, resection margins status, tumor differentiation, and completion of therapy were all shown by multivariable Cox regression to be independent survival factors. Overall survival favored patients who completed the full six courses of treatment versus those who did not (hazard ratio [HR], 0.516; 95% CI, 0.443 to 0.601; P < .001). Time to starting chemotherapy did not influence overall survival rates for the full study population (HR, 0.985; 95% CI, 0.956 to 1.015). Chemotherapy start time was an important survival factor only for the subgroup of patients who did not complete therapy, in favor of later treatment (P < .001). Conclusion Completion of all six cycles of planned adjuvant chemotherapy rather than early initiation was an independent prognostic factor after resection for pancreatic adenocarcinoma. There seems to be no difference in outcome if chemotherapy is delayed up to 12 weeks, thus allowing adequate time for postoperative recovery.
Affiliations:
- Allemagne, Australie, Canada, Finlande, France, Grèce, Hongrie, Italie, Royaume-Uni, Suède, États-Unis
- Angleterre, Attique (région), Bade-Wurtemberg, District de Karlsruhe, Grand Manchester, Hambourg, Midlands de l'Ouest, Oxfordshire, Svealand, Île-de-France
- Athènes, Birmingham, Hambourg, Heidelberg, Manchester, Oxford, Paris, Stockholm
- Université Pierre-et-Marie-Curie, Université de Birmingham, Université de Manchester
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Izbicki</name><affiliation wicri:level="3"><inist:fA14 i1="14"><s1>University of Hamburg</s1><s2>Hamburg</s2><s3>DEU</s3><sZ>18 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Mayerle, Julia" sort="Mayerle, Julia" uniqKey="Mayerle J" first="Julia" last="Mayerle">Julia Mayerle</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Ernst-Moritz-Arndt-Universitat Greifswald</s1><s2>Greifswald</s2><s3>DEU</s3><sZ>19 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Greifswald</wicri:noRegion><wicri:noRegion>Ernst-Moritz-Arndt-Universitat Greifswald</wicri:noRegion><wicri:noRegion>Ernst-Moritz-Arndt-Universitat Greifswald</wicri:noRegion></affiliation></author><author><name sortKey="Dervenis, Christos" sort="Dervenis, Christos" uniqKey="Dervenis C" first="Christos" last="Dervenis">Christos Dervenis</name><affiliation wicri:level="3"><inist:fA14 i1="17"><s1>The Agia Olga Hospital</s1><s2>Athens</s2><s3>GRC</s3><sZ>20 aut.</sZ></inist:fA14><country>Grèce</country><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Olah, Attila" sort="Olah, Attila" uniqKey="Olah A" first="Attila" last="Olah">Attila Olah</name><affiliation wicri:level="1"><inist:fA14 i1="18"><s1>The Petz Aladar Hospital</s1><s2>Gyor</s2><s3>HUN</s3><sZ>21 aut.</sZ></inist:fA14><country>Hongrie</country><wicri:noRegion>The Petz Aladar Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Butturini, Giovanni" sort="Butturini, Giovanni" uniqKey="Butturini G" first="Giovanni" last="Butturini">Giovanni Butturini</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>University of Verona</s1><s2>Verona</s2><s3>ITA</s3><sZ>8 aut.</sZ><sZ>22 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>University of Verona</wicri:noRegion></affiliation></author><author><name sortKey="Lind, Pehr A" sort="Lind, Pehr A" uniqKey="Lind P" first="Pehr A." last="Lind">Pehr A. Lind</name><affiliation wicri:level="3"><inist:fA14 i1="19"><s1>Karolinska-Stockholm Söder Hospital</s1><s2>Stockholm</s2><s3>SWE</s3><sZ>23 aut.</sZ></inist:fA14><country>Suède</country><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="Middleton, Mark R" sort="Middleton, Mark R" uniqKey="Middleton M" first="Mark R." last="Middleton">Mark R. 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Büchler</name><affiliation wicri:level="3"><inist:fA14 i1="16"><s1>University of Heidelberg</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>28 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">14-0113991</idno><date when="2014">2014</date><idno type="stanalyst">PASCAL 14-0113991 INIST</idno><idno type="RBID">Pascal:14-0113991</idno><idno type="wicri:Area/PascalFrancis/Corpus">000472</idno><idno type="wicri:Area/PascalFrancis/Curation">005989</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000168</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000168</idno><idno type="wicri:doubleKey">0732-183X:2014:Valle J:optimal:duration:and</idno><idno type="wicri:Area/Main/Merge">004092</idno><idno type="wicri:Area/Main/Curation">004032</idno><idno type="wicri:Area/Main/Exploration">004032</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Optimal Duration and Timing of Adjuvant Chemotherapy After Definitive Surgery for Ductal Adenocarcinoma of the Pancreas: Ongoing Lessons From the ESPAC-3 Study</title><author><name sortKey="Valle, Juan W" sort="Valle, Juan W" uniqKey="Valle J" first="Juan W." last="Valle">Juan W. Valle</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Manchester Academic Health Sciences Centre, Christie Hospital NHS Foundation Trust and University of Manchester</s1><s2>Manchester</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region><settlement type="city">Manchester</settlement></placeName><orgName type="university">Université de Manchester</orgName></affiliation></author><author><name sortKey="Palmer, Daniel" sort="Palmer, Daniel" uniqKey="Palmer D" first="Daniel" last="Palmer">Daniel Palmer</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust</s1><s3>GBR</s3><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust</wicri:noRegion></affiliation></author><author><name sortKey="Jackson, Richard" sort="Jackson, Richard" uniqKey="Jackson R" first="Richard" last="Jackson">Richard Jackson</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Liverpool Cancer Research UK Centre and the National Institute for Health Research Pancreas Biomedical Research Unit, University of Liverpool</s1><s2>Liverpool</s2><s3>GBR</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author><author><name sortKey="Cox, Trevor" sort="Cox, Trevor" uniqKey="Cox T" first="Trevor" last="Cox">Trevor Cox</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Liverpool Cancer Research UK Centre and the National Institute for Health Research Pancreas Biomedical Research Unit, University of Liverpool</s1><s2>Liverpool</s2><s3>GBR</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author><author><name sortKey="Neoptolemos, John P" sort="Neoptolemos, John P" uniqKey="Neoptolemos J" first="John P." last="Neoptolemos">John P. Neoptolemos</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Liverpool Cancer Research UK Centre and the National Institute for Health Research Pancreas Biomedical Research Unit, University of Liverpool</s1><s2>Liverpool</s2><s3>GBR</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author><author><name sortKey="Ghaneh, Paula" sort="Ghaneh, Paula" uniqKey="Ghaneh P" first="Paula" last="Ghaneh">Paula Ghaneh</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Liverpool Cancer Research UK Centre and the National Institute for Health Research Pancreas Biomedical Research Unit, University of Liverpool</s1><s2>Liverpool</s2><s3>GBR</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author><author><name sortKey="Rawcliffe, Charlotte L" sort="Rawcliffe, Charlotte L" uniqKey="Rawcliffe C" first="Charlotte L." last="Rawcliffe">Charlotte L. Rawcliffe</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Liverpool Cancer Research UK Centre and the National Institute for Health Research Pancreas Biomedical Research Unit, University of Liverpool</s1><s2>Liverpool</s2><s3>GBR</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author><author><name sortKey="Bassi, Claudio" sort="Bassi, Claudio" uniqKey="Bassi C" first="Claudio" last="Bassi">Claudio Bassi</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>University of Verona</s1><s2>Verona</s2><s3>ITA</s3><sZ>8 aut.</sZ><sZ>22 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>University of Verona</wicri:noRegion></affiliation></author><author><name sortKey="Stocken, Deborah D" sort="Stocken, Deborah D" uniqKey="Stocken D" first="Deborah D." last="Stocken">Deborah D. Stocken</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Cancer Research UK Clinical Trials Unit, University of Birmingham</s1><s2>Birmingham</s2><s3>GBR</s3><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region><settlement type="city">Birmingham</settlement></placeName><orgName type="university">Université de Birmingham</orgName></affiliation></author><author><name sortKey="Cunningham, David" sort="Cunningham, David" uniqKey="Cunningham D" first="David" last="Cunningham">David Cunningham</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Royal Marsden Hospital Foundation Trust</s1><s2>Sutton</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Royal Marsden Hospital Foundation Trust</wicri:noRegion></affiliation></author><author><name sortKey="O Reilly, Derek" sort="O Reilly, Derek" uniqKey="O Reilly D" first="Derek" last="O'Reilly">Derek O'Reilly</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Manchester Academic Health Sciences Centre, Christie Hospital NHS Foundation Trust and University of Manchester</s1><s2>Manchester</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region><settlement type="city">Manchester</settlement></placeName><orgName type="university">Université de Manchester</orgName></affiliation></author><author><name sortKey="Goldstein, David" sort="Goldstein, David" uniqKey="Goldstein D" first="David" last="Goldstein">David Goldstein</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Australasian GastroIntestinal Trials Group</s1><s2>Camperdown</s2><s3>AUS</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Australasian GastroIntestinal Trials Group</wicri:noRegion></affiliation></author><author><name sortKey="Robinson, Bridget A" sort="Robinson, Bridget A" uniqKey="Robinson B" first="Bridget A." last="Robinson">Bridget A. Robinson</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Australasian GastroIntestinal Trials Group</s1><s2>Camperdown</s2><s3>AUS</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Australasian GastroIntestinal Trials Group</wicri:noRegion></affiliation></author><author><name sortKey="Karapetis, Christos" sort="Karapetis, Christos" uniqKey="Karapetis C" first="Christos" last="Karapetis">Christos Karapetis</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Australasian GastroIntestinal Trials Group</s1><s2>Camperdown</s2><s3>AUS</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Australasian GastroIntestinal Trials Group</wicri:noRegion></affiliation></author><author><name sortKey="Scarfe, Andrew" sort="Scarfe, Andrew" uniqKey="Scarfe A" first="Andrew" last="Scarfe">Andrew Scarfe</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>University of Alberta</s1><s2>Edmonton</s2><s3>CAN</s3><sZ>15 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Alberta</wicri:noRegion></affiliation></author><author><name sortKey="Lacaine, Francois" sort="Lacaine, Francois" uniqKey="Lacaine F" first="Francois" last="Lacaine">Francois Lacaine</name><affiliation wicri:level="4"><inist:fA14 i1="12"><s1>Hopital TENON, Assistance Publique Hôpitaux de Paris, Universite Pierre Et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName></affiliation></author><author><name sortKey="Sand, Juhani" sort="Sand, Juhani" uniqKey="Sand J" first="Juhani" last="Sand">Juhani Sand</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Tampere University Hospital</s1><s2>Tampere</s2><s3>FIN</s3><sZ>17 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Tampere University Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Izbicki, Jakob R" sort="Izbicki, Jakob R" uniqKey="Izbicki J" first="Jakob R." last="Izbicki">Jakob R. Izbicki</name><affiliation wicri:level="3"><inist:fA14 i1="14"><s1>University of Hamburg</s1><s2>Hamburg</s2><s3>DEU</s3><sZ>18 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Mayerle, Julia" sort="Mayerle, Julia" uniqKey="Mayerle J" first="Julia" last="Mayerle">Julia Mayerle</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Ernst-Moritz-Arndt-Universitat Greifswald</s1><s2>Greifswald</s2><s3>DEU</s3><sZ>19 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Greifswald</wicri:noRegion><wicri:noRegion>Ernst-Moritz-Arndt-Universitat Greifswald</wicri:noRegion><wicri:noRegion>Ernst-Moritz-Arndt-Universitat Greifswald</wicri:noRegion></affiliation></author><author><name sortKey="Dervenis, Christos" sort="Dervenis, Christos" uniqKey="Dervenis C" first="Christos" last="Dervenis">Christos Dervenis</name><affiliation wicri:level="3"><inist:fA14 i1="17"><s1>The Agia Olga Hospital</s1><s2>Athens</s2><s3>GRC</s3><sZ>20 aut.</sZ></inist:fA14><country>Grèce</country><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Olah, Attila" sort="Olah, Attila" uniqKey="Olah A" first="Attila" last="Olah">Attila Olah</name><affiliation wicri:level="1"><inist:fA14 i1="18"><s1>The Petz Aladar Hospital</s1><s2>Gyor</s2><s3>HUN</s3><sZ>21 aut.</sZ></inist:fA14><country>Hongrie</country><wicri:noRegion>The Petz Aladar Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Butturini, Giovanni" sort="Butturini, Giovanni" uniqKey="Butturini G" first="Giovanni" last="Butturini">Giovanni Butturini</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>University of Verona</s1><s2>Verona</s2><s3>ITA</s3><sZ>8 aut.</sZ><sZ>22 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>University of Verona</wicri:noRegion></affiliation></author><author><name sortKey="Lind, Pehr A" sort="Lind, Pehr A" uniqKey="Lind P" first="Pehr A." last="Lind">Pehr A. Lind</name><affiliation wicri:level="3"><inist:fA14 i1="19"><s1>Karolinska-Stockholm Söder Hospital</s1><s2>Stockholm</s2><s3>SWE</s3><sZ>23 aut.</sZ></inist:fA14><country>Suède</country><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="Middleton, Mark R" sort="Middleton, Mark R" uniqKey="Middleton M" first="Mark R." last="Middleton">Mark R. Middleton</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Churchill Hospital, Oxford University Hospitals NHS Trust</s1><s2>Oxford</s2><s3>USA</s3><sZ>24 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName></affiliation></author><author><name sortKey="Anthoney, Alan" sort="Anthoney, Alan" uniqKey="Anthoney A" first="Alan" last="Anthoney">Alan Anthoney</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>The Leeds Teaching Hospital Trust</s1><s2>Leeds</s2><s3>GBR</s3><sZ>25 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>The Leeds Teaching Hospital Trust</wicri:noRegion></affiliation></author><author><name sortKey="Sumpter, Kate" sort="Sumpter, Kate" uniqKey="Sumpter K" first="Kate" last="Sumpter">Kate Sumpter</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Freeman Hospital, Newcastle upon Tyne; Ross Carter, Glasgow Royal Infirmary</s1><s2>Glasgow</s2><s3>USA</s3><sZ>26 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Glasgow</wicri:noRegion></affiliation></author><author><name sortKey="Carter, Ross" sort="Carter, Ross" uniqKey="Carter R" first="Ross" last="Carter">Ross Carter</name></author><author><name sortKey="Buchler, Markus W" sort="Buchler, Markus W" uniqKey="Buchler M" first="Markus W." last="Büchler">Markus W. Büchler</name><affiliation wicri:level="3"><inist:fA14 i1="16"><s1>University of Heidelberg</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>28 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of clinical oncology</title><title level="j" type="abbreviated">J. clin. oncol.</title><idno type="ISSN">0732-183X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of clinical oncology</title><title level="j" type="abbreviated">J. clin. oncol.</title><idno type="ISSN">0732-183X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adenocarcinoma</term><term>Adjuvant treatment</term><term>Cancerology</term><term>Chemotherapy</term><term>Duration</term><term>Pancreas</term><term>Surgery</term><term>Timing</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Chimiothérapie</term><term>Durée</term><term>Timing</term><term>Adénocarcinome</term><term>Traitement adjuvant</term><term>Pancréas</term><term>Chirurgie</term><term>Cancérologie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Purpose Adjuvant chemotherapy improves patient survival rates after resection for pancreatic adenocarcinoma, but the optimal duration and time to initiate chemotherapy is unknown. Patients and Methods Patients with pancreatic ductal adenocarcinoma treated within the international, phase III, European Study Group for Pancreatic Cancer-3 (version 2) study were included if they had been randomly assigned to chemotherapy. Overall survival analysis was performed on an intention-to-treat basis, retaining patients in their randomized groups, and adjusting the overall treatment effect by known prognostic variables as well as the start time of chemotherapy. Results There were 985 patients, of whom 486 (49%) received gemcitabine and 499 (51%) received fluorouracil; 675 patients (68%) completed all six cycles of chemotherapy (full course) and 293 patients (30%) completed one to five cycles. Lymph node involvement, resection margins status, tumor differentiation, and completion of therapy were all shown by multivariable Cox regression to be independent survival factors. Overall survival favored patients who completed the full six courses of treatment versus those who did not (hazard ratio [HR], 0.516; 95% CI, 0.443 to 0.601; P < .001). Time to starting chemotherapy did not influence overall survival rates for the full study population (HR, 0.985; 95% CI, 0.956 to 1.015). Chemotherapy start time was an important survival factor only for the subgroup of patients who did not complete therapy, in favor of later treatment (P < .001). Conclusion Completion of all six cycles of planned adjuvant chemotherapy rather than early initiation was an independent prognostic factor after resection for pancreatic adenocarcinoma. There seems to be no difference in outcome if chemotherapy is delayed up to 12 weeks, thus allowing adequate time for postoperative recovery.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Canada</li><li>Finlande</li><li>France</li><li>Grèce</li><li>Hongrie</li><li>Italie</li><li>Royaume-Uni</li><li>Suède</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Attique (région)</li><li>Bade-Wurtemberg</li><li>District de Karlsruhe</li><li>Grand Manchester</li><li>Hambourg</li><li>Midlands de l'Ouest</li><li>Oxfordshire</li><li>Svealand</li><li>Île-de-France</li></region><settlement><li>Athènes</li><li>Birmingham</li><li>Hambourg</li><li>Heidelberg</li><li>Manchester</li><li>Oxford</li><li>Paris</li><li>Stockholm</li></settlement><orgName><li>Université Pierre-et-Marie-Curie</li><li>Université de Birmingham</li><li>Université de Manchester</li></orgName></list><tree><noCountry><name sortKey="Carter, Ross" sort="Carter, Ross" uniqKey="Carter R" first="Ross" last="Carter">Ross Carter</name></noCountry><country name="États-Unis"><region name="Angleterre"><name sortKey="Valle, Juan W" sort="Valle, Juan W" uniqKey="Valle J" first="Juan W." last="Valle">Juan W. Valle</name></region><name sortKey="Middleton, Mark R" sort="Middleton, Mark R" uniqKey="Middleton M" first="Mark R." last="Middleton">Mark R. Middleton</name><name sortKey="O Reilly, Derek" sort="O Reilly, Derek" uniqKey="O Reilly D" first="Derek" last="O'Reilly">Derek O'Reilly</name><name sortKey="Sumpter, Kate" sort="Sumpter, Kate" uniqKey="Sumpter K" first="Kate" last="Sumpter">Kate Sumpter</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Palmer, Daniel" sort="Palmer, Daniel" uniqKey="Palmer D" first="Daniel" last="Palmer">Daniel Palmer</name></noRegion><name sortKey="Anthoney, Alan" sort="Anthoney, Alan" uniqKey="Anthoney A" first="Alan" last="Anthoney">Alan Anthoney</name><name sortKey="Cox, Trevor" sort="Cox, Trevor" uniqKey="Cox T" first="Trevor" last="Cox">Trevor Cox</name><name sortKey="Cunningham, David" sort="Cunningham, David" uniqKey="Cunningham D" first="David" last="Cunningham">David Cunningham</name><name sortKey="Ghaneh, Paula" sort="Ghaneh, Paula" uniqKey="Ghaneh P" first="Paula" last="Ghaneh">Paula Ghaneh</name><name sortKey="Jackson, Richard" sort="Jackson, Richard" uniqKey="Jackson R" first="Richard" last="Jackson">Richard Jackson</name><name sortKey="Neoptolemos, John P" sort="Neoptolemos, John P" uniqKey="Neoptolemos J" first="John P." last="Neoptolemos">John P. Neoptolemos</name><name sortKey="Rawcliffe, Charlotte L" sort="Rawcliffe, Charlotte L" uniqKey="Rawcliffe C" first="Charlotte L." last="Rawcliffe">Charlotte L. Rawcliffe</name><name sortKey="Stocken, Deborah D" sort="Stocken, Deborah D" uniqKey="Stocken D" first="Deborah D." last="Stocken">Deborah D. Stocken</name></country><country name="Italie"><noRegion><name sortKey="Bassi, Claudio" sort="Bassi, Claudio" uniqKey="Bassi C" first="Claudio" last="Bassi">Claudio Bassi</name></noRegion><name sortKey="Butturini, Giovanni" sort="Butturini, Giovanni" uniqKey="Butturini G" first="Giovanni" last="Butturini">Giovanni Butturini</name></country><country name="Australie"><noRegion><name sortKey="Goldstein, David" sort="Goldstein, David" uniqKey="Goldstein D" first="David" last="Goldstein">David Goldstein</name></noRegion><name sortKey="Karapetis, Christos" sort="Karapetis, Christos" uniqKey="Karapetis C" first="Christos" last="Karapetis">Christos Karapetis</name><name sortKey="Robinson, Bridget A" sort="Robinson, Bridget A" uniqKey="Robinson B" first="Bridget A." last="Robinson">Bridget A. Robinson</name></country><country name="Canada"><noRegion><name sortKey="Scarfe, Andrew" sort="Scarfe, Andrew" uniqKey="Scarfe A" first="Andrew" last="Scarfe">Andrew Scarfe</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Lacaine, Francois" sort="Lacaine, Francois" uniqKey="Lacaine F" first="Francois" last="Lacaine">Francois Lacaine</name></region></country><country name="Finlande"><noRegion><name sortKey="Sand, Juhani" sort="Sand, Juhani" uniqKey="Sand J" first="Juhani" last="Sand">Juhani Sand</name></noRegion></country><country name="Allemagne"><region name="Hambourg"><name sortKey="Izbicki, Jakob R" sort="Izbicki, Jakob R" uniqKey="Izbicki J" first="Jakob R." last="Izbicki">Jakob R. Izbicki</name></region><name sortKey="Buchler, Markus W" sort="Buchler, Markus W" uniqKey="Buchler M" first="Markus W." last="Büchler">Markus W. Büchler</name><name sortKey="Mayerle, Julia" sort="Mayerle, Julia" uniqKey="Mayerle J" first="Julia" last="Mayerle">Julia Mayerle</name></country><country name="Grèce"><region name="Attique (région)"><name sortKey="Dervenis, Christos" sort="Dervenis, Christos" uniqKey="Dervenis C" first="Christos" last="Dervenis">Christos Dervenis</name></region></country><country name="Hongrie"><noRegion><name sortKey="Olah, Attila" sort="Olah, Attila" uniqKey="Olah A" first="Attila" last="Olah">Attila Olah</name></noRegion></country><country name="Suède"><region name="Svealand"><name sortKey="Lind, Pehr A" sort="Lind, Pehr A" uniqKey="Lind P" first="Pehr A." last="Lind">Pehr A. Lind</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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