辅助治疗与新辅助化疗和手术后胰腺癌生存率的改善相关。然而，在这种情况下，辅助治疗是否应包括放疗尚不清楚。本研究查询了国家癌症数据库中2010年至2019年间在多药新辅助化疗后接受根治性切除并接受辅助治疗的胰腺腺癌患者。辅助化疗加放疗（外照射，45-50.4 灰）与单独辅助化疗进行比较。单变量和多变量 Cox 回归用于评估生存关联。在倾向评分匹配的亚组中重复进行分析。在多药新辅助化疗和切除术后接受辅助治疗的 1983 例患者中，1502 例（75.7%）仅接受辅助化疗，481 例（24.3%）接受伴随辅助放疗（放化疗）。接受辅助放化疗的患者年龄较小，在非学术机构接受治疗的频率较高，淋巴结转移率（ypN1-2）、切缘阳性率（R1）和淋巴管侵犯率（LVI）较高。根据未经调整的分析，接受放化疗的患者的中位生存期较短（26.8 个月 vs 33.2 个月；p = 0.0017）。调整混杂因素后，在多变量模型中，放化疗与更好的结果相关（风险比 [HR]，0.75；95% 置信区间 [CI]，0.61-0.93；p = 0.008）。对于 III 级肿瘤（HR，0.53；95% CI，0.37-0.74）或 LVI 肿瘤（HR，0.58；95% CI，0.44-0.75）患者，放化疗与改善预后之间的相关性更强。在 396 名倾向匹配患者的亚组中，放化疗仅与 LVI 或 III 级肿瘤患者的生存获益相关。在多药新辅助化疗和胰腺癌切除术后，与单独辅助化疗相比，额外的辅助放化疗与生存改善相关适用于 LVI 或 III 级肿瘤患者。© 2024。外科肿瘤学会。

Adjuvant therapy is associated with improved pancreatic cancer survival after neoadjuvant chemotherapy and surgery. However, whether adjuvant treatment should include radiotherapy is unclear in this setting.This study queried the National Cancer Database for pancreatic adenocarcinoma patients who underwent curative resection after multiagent neoadjuvant chemotherapy between 2010 and 2019 and received adjuvant treatment. Adjuvant chemotherapy plus radiotherapy (external beam, 45-50.4 gray) was compared with adjuvant chemotherapy alone. Uni- and multivariable Cox regression was used to assess survival associations. Analyses were repeated in a propensity score-matched subgroup.Of 1983 patients who received adjuvant treatment after multiagent neoadjuvant chemotherapy and resection, 1502 (75.7%) received adjuvant chemotherapy alone and 481 (24.3%) received concomitant adjuvant radiotherapy (chemoradiotherapy). The patients treated with adjuvant chemoradiotherapy were younger, were treated at non-academic facilities more often, and had higher rates of lymph node metastasis (ypN1-2), positive resection margins (R1), and lymphovascular invasion (LVI+). The median survival was shorter for the chemoradiotherapy-treated patients according to the unadjusted analysis (26.8 vs 33.2 months; p = 0.0017). After adjustment for confounders, chemoradiotherapy was associated with better outcomes in the multivariable model (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.61-0.93; p = 0.008). The association between chemoradiotherapy and improved outcomes was stronger for the patients with grade III tumors (HR, 0.53; 95% CI, 0.37-0.74) or LVI+ tumors (HR, 0.58; 95% CI, 0.44-0.75). In a subgroup of 396 propensity-matched patients, chemoradiotherapy was associated with a survival benefit only for the patients with LVI+ or grade III tumors.After multiagent neoadjuvant chemotherapy and resection for pancreatic cancer, additional adjuvant chemoradiotherapy versus adjuvant chemotherapy alone is associated with improved survival for patients with LVI+ or grade III tumors.© 2024. Society of Surgical Oncology.