Park Joo Kyung, Yoon Yong Bum, Kim Yong-Tae, Ryu Ji Kon, Yoon Won Jae, Lee Sang Hyub
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Clin Gastroenterol. 2008 Jan;42(1):86-91. doi: 10.1097/01.mcg.0000225657.30803.9d.
The aim of this study was to evaluate the prognostic significance of clinical and laboratory variables, and to investigate survival benefits for different treatment modalities in unresectable pancreatic cancer.
The majority of pancreatic cancers are found to be unresectable. Therefore, estimations of prognosis and decisions of treatment modalities are important in optimizing the various aspects of care.
Three hundred and forty unresectable locally advanced, or metastatic pancreatic cancer patients were enrolled from January 1998 to January 2005 at the Seoul National University Hospital.
One hundred and five patients received chemotherapy only and 59 patients received concurrent chemoradiotherapy (CCRT). Age, performance status, tumor location, initial CA 19-9 level, American Joint Committee on Cancer stage, and treatment modality (supportive care only, chemotherapy, vs. CCRT) were found to have prognostic significance for overall survival (OS) by univariate analysis, whereas initial CA 19-9 level, stage, and treatment modality were identified as independent prognostic factors by multivariate analysis. In subgroup analysis, stage III patients treated by CCRT (median OS, 10.4 mo) or chemotherapy alone (11.3 mo) showed survival benefit over supportive care (6.4 mo), and stage IV patients treated by chemotherapy alone (6.4 mo) showed survival benefit over supportive care (3.1 mo).
Initial CA 19-9, American Joint Committee on Cancer stage, and treatment modality were independent prognostic factors of OS, and the patients who received chemotherapy or CCRT showed better survival than those who received supportive care only.
本研究旨在评估临床和实验室变量的预后意义，并探讨不可切除胰腺癌不同治疗方式的生存获益情况。
大多数胰腺癌被发现不可切除。因此，预后评估和治疗方式的决策对于优化各方面护理至关重要。
1998年1月至2005年1月，首尔国立大学医院招募了340例不可切除的局部晚期或转移性胰腺癌患者。
105例患者仅接受化疗，59例患者接受同步放化疗（CCRT）。单因素分析发现年龄、体能状态、肿瘤位置、初始CA 19-9水平、美国癌症联合委员会分期以及治疗方式（仅支持治疗、化疗与CCRT）对总生存期（OS）具有预后意义，而多因素分析确定初始CA 19-9水平、分期和治疗方式为独立预后因素。亚组分析中，接受CCRT（中位OS，10.4个月）或单纯化疗（11.3个月）的III期患者比支持治疗（6.4个月）有生存获益，接受单纯化疗（6.4个月）的IV期患者比支持治疗（3.1个月）有生存获益。
初始CA 19-9、美国癌症联合委员会分期和治疗方式是OS的独立预后因素，接受化疗或CCRT的患者比仅接受支持治疗的患者生存更好。
