转移性胰腺癌患者的总生存状况略有改善：1988 年至 2008 年监测、流行病学和最终结果登记处的趋势分析。

Modest improvement in overall survival for patients with metastatic pancreatic cancer: a trend analysis using the surveillance, epidemiology, and end results registry from 1988 to 2008.

机构信息

From the *Department of Surgery, Duke University Medical Center, Durham, NC; †Department of Visceral Surgery and Medicine, University of Bern, Bern; and ‡Department of Medical Oncology and Hematology, Cantonal Hospital St Gallen, Gallen, Switzerland.

出版信息

Pancreas. 2013 Oct;42(7):1157-63. doi: 10.1097/MPA.0b013e318291fbc5.

DOI:10.1097/MPA.0b013e318291fbc5

PMID:23867367

Abstract

OBJECTIVES

Patients with pancreatic adenocarcinoma often present with distant metastatic disease. We aimed to assess whether improvements in survival of clinical trials translated to a population-based level.

METHODS

The US Surveillance, Epidemiology, and End Results registry was queried. Adult patients with distant metastatic adenocarcinoma of the pancreas were included from 1988 to 2008. Overall survival was analyzed using Kaplan-Meier curves as well as multivariable-adjusted Cox proportional hazards models.

RESULTS

In total, 32,452 patients were included. Mean age was 67.6 (SD: 11.7) years, and 15,341 (47.3%) were female. Median overall survival was 3 months (95% confidence interval [CI], 3-3 months), which increased from 2 (CI, 2-2) months in 1988 to 3 (CI, 3-4) months in 2008. After adjustment for multiple covariates, the hazard ratio (HR) decreased by 0.977 per year (CI, 0.975-0.980). In multivariable-adjusted survival analyses, tumor location in the pancreatic body/tail (HR, 1.10), male sex (HR, 1.09), increasing age (HR, 1.016), African American ethnicity (HR, 1.16), nonmarried civil status (HR, 1.18), and absence of radiotherapy (HR, 1.41) were associated with worse survival (P < 0.001 for all predictors).

CONCLUSIONS

The improvement in overall survival over the past 2 decades among patients with metastatic pancreatic adenocarcinoma is modest and disappointing. More effective therapeutic strategies for advanced disease are desperately needed.

摘要

目的

胰腺腺癌患者常伴有远处转移疾病。本研究旨在评估临床试验中的生存改善是否转化为基于人群的水平。

方法

通过美国监测、流行病学和最终结果（Surveillance, Epidemiology, and End Results，SEER）数据库查询。纳入 1988 年至 2008 年期间患有远处转移性胰腺腺癌的成年患者。采用 Kaplan-Meier 曲线和多变量调整 Cox 比例风险模型分析总生存期。

结果

共纳入 32452 例患者。平均年龄为 67.6（标准差：11.7）岁，15341 例（47.3%）为女性。中位总生存期为 3 个月（95%置信区间 [CI]，3-3 个月），从 1988 年的 2 个月（CI，2-2 个月）增加到 2008 年的 3 个月（CI，3-4 个月）。在调整多个协变量后，每年的风险比（hazard ratio，HR）降低 0.977（CI，0.975-0.980）。在多变量调整的生存分析中，肿瘤位于胰体/尾部（HR，1.10）、男性（HR，1.09）、年龄增长（HR，1.016）、非裔美国人（HR，1.16）、未婚（HR，1.18）和未接受放疗（HR，1.41）与生存较差相关（所有预测因素的 P<0.001）。