胰腺腺癌切除术后的辅助治疗和生存：基于人群的分析。

Adjuvant therapy and survival after resection of pancreatic adenocarcinoma: a population-based analysis.

机构信息

Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.

出版信息

Cancer. 2010 Jun 15;116(12):2932-40. doi: 10.1002/cncr.25082.

DOI:10.1002/cncr.25082

PMID:20336787

Abstract

BACKGROUND

The use of adjuvant chemoradiation for pancreatic adenocarcinoma (PAC) is accepted in North America, but there is a paucity of data to support this practice. The relation between adjuvant therapy and survival was assessed in a population-based cohort of patients with PAC.

METHODS

A review was conducted of all cases of resected PAC from 1996 to 2003 using data from the state cancer registry augmented with data from primary medical record review. Use of adjuvant therapy was ascertained from registry data. Survival was assessed using the Kaplan-Meier method, and a Cox proportional hazards model was developed for multivariate analysis.

RESULTS

A total of 298 patients from 27 hospitals met criteria for inclusion. There were 228 patients (76.5%) who were resected with curative intent, with a median overall survival of 12 months. The 6-month, 1-year, and 5-year survival rates were 80.2%, 58.4%, and 6.7%, respectively. Of the 228 patients resected, 122 (53.5%) received adjuvant treatment and had a median survival of 13.0 months versus 11.0 months for those with no adjuvant treatment (P = .16). After adjustment for surrogates of performance status, significant predictors of overall survival included no weight loss, T1/T2 pathologic stage, a microscopically complete resection (R0), and receipt of adjuvant therapy.

CONCLUSIONS

An R0 resection and adjuvant therapy were found to be independently associated with an increase in overall survival in patients with resected PAC. These data underscore the importance of adjuvant therapy in resected PAC and the need for ongoing clinical trials to refine the efficacy and timing of adjuvant therapy in this disease.

摘要

背景

在北美，辅助放化疗被用于治疗胰腺腺癌（PAC），但支持这种治疗的证据有限。本研究旨在评估接受辅助治疗的 PAC 患者的生存情况。

方法

通过对州癌症登记处的数据进行回顾性分析，并结合对原始医疗记录的审核，评估了 1996 年至 2003 年期间所有接受手术切除的 PAC 患者的生存情况。从登记处的数据中确定辅助治疗的使用情况。使用 Kaplan-Meier 方法评估生存情况，并建立 Cox 比例风险模型进行多变量分析。

结果

共有 27 家医院的 298 名患者符合纳入标准。其中 228 例（76.5%）为根治性切除，中位总生存期为 12 个月。6 个月、1 年和 5 年生存率分别为 80.2%、58.4%和 6.7%。在 228 例接受根治性切除术的患者中，122 例（53.5%）接受了辅助治疗，中位生存期为 13.0 个月，而未接受辅助治疗的患者中位生存期为 11.0 个月（P =.16）。在调整了体能状态的替代指标后，总生存的显著预测因素包括无体重减轻、T1/T2 病理分期、显微镜下完全切除（R0）和接受辅助治疗。