Impact of Institutional Radiotherapy Patient Volume on Postoperative and Oncologic Outcomes After Neoadjuvant Radiation for Pancreatic Cancer.

INTRODUCTION Neoadjuvant radiation therapy (NRT) is beneficial in gastrointestinal cancers, but its role in pancreatic ductal adenocarcinoma (PDAC) remains uncertain. It is unclear if hospital-level NRT volume is an important factor when treating PDAC with NRT.

Methods

The National Cancer Database (2011-2019) was used to identify PDAC patients who received NRT followed by surgical resection. Hospital NRT volume was defined in two ways: mean annual number of patients treated for (1) PDAC and (2) esophageal/rectal cancers. Hospitals were categorized as low (<90th percentile) or high (≥90th percentile) volume. Multivariable logistic regression and Cox proportional hazards models evaluated associations between hospital NRT volume, overall survival (OS), 30-day readmission, and surgical margin status.

Results

Among 2879 PDAC patients, receiving NRT at low-volume hospitals was associated with lower OS (esophageal/rectal cancer NRT hospital volume, HR 1.16, 95% CI 1.05-1.29, p = 0.005; PDAC NRT hospital volume, HR 1.25, 95% CI 1.11-1.41, p < 0.001). Annual average patient volume of NRT for PDAC at the hospital level as a continuous variable was associated with a decrease in the adjusted log odds of 30-day readmissions and positive surgical margins.

Conclusions

Higher institutional NRT volume was associated with higher OS and lower 30-day readmissions and positive surgical margins among PDAC patients.