BMC Gastroenterol. 2013 Aug 31;13:134. doi: 10.1186/1471-230X-13-134.
BACKGROUND: Although the outcomes of pancreatic cancer have been improved by gemcitabine, the changes in its characteristics and long-term outcomes within the gemcitabine era remain unclear. This study was conducted to identify clinical characteristics of pancreatic cancer patients within the gemcitabine era. METHODS: A retrospective chart review was performed at 10 centers for 1,248 consecutive patients who were ever considered to have a diagnosis of pancreatic cancer between 2001 and 2010. Data collected included demographics, diagnosis date, clinical stage, treatment, and outcome 1,082 patients met the inclusion criteria and were analyzed further. The chi-square test, Student's t-test, and Mann-Whitney U-test were used for statistical analysis. Outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Differences in survival analyses were determined using the log-rank test. RESULTS: The distribution of clinical stages was: I, 2.2% II, 3.4% III, 13% IVa, 27% and IVb, 55%. Chemotherapy alone was administered to 42% of patients and 17% underwent resection. The 1-, 3-, and 5-year survival rates were 39%, 13%, and 6.9%, respectively. The median survival time was 257 days, but differed considerably among treatments and clinical stages. Demographics, distribution of clinical stage, and cause of death did not differ between groups A (2001-2005, n=406) and B (2006-2010, n=676). However, group B included more patients who underwent chemotherapy (P<0.0001) and fewer treated with best supportive care (P=0.0004), mirroring improvements in this group's long-term outcomes (P=0.0063). Finally, factors associated with long-term outcomes derived from multivariate analysis were clinical stage (P<0.0001), location of the tumor (P=0.0294) and treatments (surgery, chemotherapy) (<0.0001). CONCLUSIONS: Long-term outcomes in pancreatic cancer has improved even within the gemcitabine era, suggesting the importance of offering chemotherapy to patients previously only considered for best supportive care. Most patients are still diagnosed at an advanced stage, making clinical strategy development for diagnosing pancreatic cancer at earlier stages essential.
背景：虽然吉西他滨已改善胰腺癌的预后，但吉西他滨时代其特征和长期预后的变化仍不清楚。本研究旨在确定吉西他滨时代胰腺癌患者的临床特征。
方法：在 10 个中心对 1248 例连续患者进行回顾性图表审查，这些患者曾于 2001 年至 2010 年间被考虑诊断为胰腺癌。收集的数据包括人口统计学资料、诊断日期、临床分期、治疗和结局。1082 例患者符合纳入标准，并进一步进行分析。采用卡方检验、学生 t 检验和曼-惠特尼 U 检验进行统计学分析。采用 Kaplan-Meier 法和 Cox 比例风险回归进行生存分析。采用对数秩检验确定生存分析差异。
结果：临床分期分布为：I 期，2.2%；II 期，3.4%；III 期，13%；IVa 期，27%；IVb 期，55%。42%的患者接受单独化疗，17%的患者接受手术治疗。1 年、3 年和 5 年生存率分别为 39%、13%和 6.9%。中位生存时间为 257 天，但不同治疗和临床分期之间差异较大。两组 A（2001-2005 年，n=406）和 B（2006-2010 年，n=676）之间的人口统计学资料、临床分期分布和死因无差异。然而，组 B 中接受化疗的患者更多（P<0.0001），接受最佳支持治疗的患者更少（P=0.0004），这反映出该组长期预后的改善（P=0.0063）。最后，多变量分析得出与长期预后相关的因素包括临床分期（P<0.0001）、肿瘤位置（P=0.0294）和治疗方法（手术、化疗）（P<0.0001）。
结论：即使在吉西他滨时代，胰腺癌的长期预后也有所改善，这表明向以前仅考虑最佳支持治疗的患者提供化疗的重要性。大多数患者仍被诊断为晚期，因此制定在更早阶段诊断胰腺癌的临床策略至关重要。
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