Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
J Gastroenterol. 2010 Nov;45(11):1146-54. doi: 10.1007/s00535-010-0258-9. Epub 2010 Jun 15.
Gemcitabine (GEM) is the key drug for the chemotherapy of unresectable pancreatic cancer. However, the efficacy and safety of GEM has not been established in elderly patients. We retrospectively examined the prognosis of elderly pancreatic cancer patients treated with GEM.
Sixty-six patients with unresectable pancreatic cancer (pathologically identified) and no prior chemotherapy were divided into three groups. Group A: patients aged 70 years or more who received standard GEM (1000 mg/m(2)) on days 1, 8, and 15 and rest on day 21; Group B: patients less than 70 years old who received standard GEM therapy; and Group C: patients under best supportive care.
Median survival times (MSTs) (days) were 311 in group A (p < 0.05 vs. group C), 292 in group B (p < 0.05 vs. group C), and 127 in group C. Among the patients who received GEM, 23% patients in group A and 16% patients in group B obtained partial responses. The response rates and MSTs were similar in groups A and B, as well as in more aged (≥75 years) patients. Bone marrow suppression was more frequently seen in elderly patients. Cox's hazard model in patients aged 70 years or more revealed that GEM therapy reduced the hazard ratio for death (hazard ratio: 0.683, p = 0.041).
Chemotherapy with GEM appears to be effective and safe in elderly patients as well as in younger patients. Patients with unresectable pancreatic carcinoma should receive GEM therapy even if they are aged 70 or more, even if they are aged 75 or more.
吉西他滨（GEM）是不可切除胰腺癌化疗的关键药物。然而，在老年患者中尚未确定 GEM 的疗效和安全性。我们回顾性检查了接受 GEM 治疗的老年胰腺癌患者的预后。
将 66 名（经病理证实）不可切除的胰腺癌且未接受过化疗的患者分为三组。A 组：年龄 70 岁或以上的患者，接受标准 GEM（1000mg/m²），第 1、8 和 15 天给药，第 21 天休息；B 组：年龄小于 70 岁的患者，接受标准 GEM 治疗；C 组：接受最佳支持治疗的患者。
A 组的中位生存时间（MST）（天）为 311（p<0.05 与 C 组相比），B 组为 292（p<0.05 与 C 组相比），C 组为 127。在接受 GEM 的患者中，A 组有 23%的患者和 B 组有 16%的患者获得部分缓解。A 组和 B 组的缓解率和 MST 相似，高龄（≥75 岁）患者也如此。骨髓抑制在老年患者中更为常见。在年龄 70 岁或以上的患者中，Cox 风险模型显示 GEM 治疗降低了死亡风险比（风险比：0.683，p=0.041）。
GEM 化疗在老年患者和年轻患者中均有效且安全。即使患者年龄在 70 岁或以上，甚至 75 岁或以上，患有不可切除的胰腺癌也应接受 GEM 治疗。
