Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Cancer. 2010 Apr 1;116(7):1681-90. doi: 10.1002/cncr.24918.
: Pancreatic adenocarcinoma is a deadly disease; however, recent studies have suggested improved outcomes in patients with locoregional cancer. Progress was evaluated at a national level in resected patients, as measured by the proportion who received guideline-directed treatment and trends in survival.
: The linked Surveillance, Epidemiology, and End Results and Medicare databases were queried to identify resections for pancreatic adenocarcinoma performed between 1991 and 2002. Receipt and timing of chemotherapy and radiation with respect to time-trend were assessed. Using logistic regression, factors associated with adjuvant combination chemoradiotherapy were identified. Kaplan-Meier curves stratified by year and treatment were used to assess survival.
: Of the 1910 patients, 47.9% (n = 915) received some form of adjuvant therapy within the first 6 months postoperatively; 34.4% (n = 658) received combination chemoradiotherapy (chemoRT). ChemoRT demonstrated a significant increase, from 29.2% to 37.5% (P < .0001). Neoadjuvant therapy was used in 5.7% (n = 108) of patients; no trend was observed during the study (P = .1275). The in-hospital mortality rate was 8.0% (n = 153 patients); no significant trend was noted (P = .3116). Kaplan-Meier survival, stratified by year group of diagnosis, did not change significantly over time (log-rank test, P = .4381), even with comparisons of the first 3 years with the last 3 years of the study (log-rank test, P = .3579).
: Adherence to guideline-directed care isimproving in the United States; however, the pace is slow, and overall survival has yet to be impacted significantly. Both increased use of adjuvant therapy and the development of more promising systemic treatments are necessary to improve survival for patients with resectable pancreatic cancer. Cancer 2010. (c) 2010 American Cancer Society.
胰腺腺癌是一种致命的疾病；然而，最近的研究表明，局部癌症患者的预后有所改善。在接受手术的患者中，从接受指南指导治疗的比例和生存趋势方面，在全国范围内评估了进展情况。
通过查询 1991 年至 2002 年间进行的胰腺腺癌切除术的监测、流行病学和最终结果与医疗保险数据库，确定接受切除术的患者。评估化疗和放疗的接受情况和时间趋势。使用逻辑回归，确定与辅助联合放化疗相关的因素。使用 Kaplan-Meier 曲线，按年份和治疗分层，评估生存情况。
在 1910 例患者中，47.9%（n=915）在术后 6 个月内接受了某种形式的辅助治疗；34.4%（n=658）接受了联合放化疗（chemoRT）。chemoRT 的比例显著增加，从 29.2%增加到 37.5%（P<.0001）。新辅助治疗用于 5.7%（n=108）的患者；在研究期间未观察到趋势（P=.1275）。住院死亡率为 8.0%（n=153 例）；未观察到显著趋势（P=.3116）。Kaplan-Meier 生存分析，按诊断年份组分层，随时间变化无显著变化（对数秩检验，P=.4381），即使与研究前 3 年与后 3 年的比较（对数秩检验，P=.3579）。
在美国，遵循指南指导的治疗方法正在改善；然而，进展缓慢，总体生存率尚未受到显著影响。增加辅助治疗的使用和开发更有前途的系统治疗方法，对于提高可切除胰腺癌患者的生存率是必要的。癌症 2010。（c）2010 年美国癌症协会。
