Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Healthy Aging Clinic and Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Am Coll Surg. 2014 Jul;219(1):111-20. doi: 10.1016/j.jamcollsurg.2014.02.023. Epub 2014 Mar 13.
A well-defined treatment strategy for elderly patients with resectable pancreatic cancer is lacking. Multiple reports have described highly selected older cancer patients who have successfully undergone pancreatectomy. However, multimodality therapy is essential for long-term survival, and elderly patients are at high risk for not receiving adjuvant therapy postoperatively. We sought to describe the treatment patterns and outcomes of a series of elderly patients with pancreatic cancer who were treated with a multimodality strategy that liberally used neoadjuvant therapy.
We retrospectively reviewed treatment plans, short-term outcomes, and overall survival of all patients 70 years old and older, presenting to our institution over a 9-year period, who were treated for potentially resectable or borderline resectable pancreatic cancer.
There were 179 (76%) of 236 patients treated with curative intent. Of these patients, 153 (85%) initiated neoadjuvant therapy: 74 (48%) subsequently underwent pancreatectomy and 79 did not due to disease progression (n = 46), insufficient performance status (n = 23), or other reasons (n = 10). Eleven (42%) of 26 patients who underwent surgery first received postoperative therapy. Among patients treated with curative intent, the median overall survival of all patients initiating neoadjuvant therapy (16.6 months [range 2.1 to 142.7 months]) was similar to that of patients undergoing resection primarily (15.1 months [range 5.4 to 100.8 months]), p = 0.53. After pancreatectomy, patients had a 2% in-hospital mortality rate and 91% were discharged home.
Eighty-five percent of all patients 70 years old and older, who underwent pancreatectomy for potentially resectable or borderline resectable pancreatic cancer, received multimodality therapy. More than 90% were discharged home. These data demonstrate a potential role for neoadjuvant therapy in selecting elderly patients for surgery, and support further studies to refine individualized treatment protocols for this high-risk population.
对于可切除的胰腺癌老年患者，尚缺乏明确的治疗策略。有多项报道描述了经过精心选择的老年癌症患者成功接受了胰腺切除术。然而，多模式治疗对于长期生存至关重要，而老年患者术后接受辅助治疗的风险很高。我们旨在描述一组接受新辅助治疗的广泛应用的多模式策略治疗的老年胰腺癌患者的治疗模式和结果。
我们回顾性分析了 9 年来我院收治的所有年龄在 70 岁及以上、接受潜在可切除或边界可切除胰腺癌治疗的患者的治疗计划、短期结局和总生存情况。
有 236 例患者中有 179 例（76%）接受了根治性治疗。其中，153 例（85%）患者接受了新辅助治疗：74 例（48%）随后接受了胰腺切除术，79 例因疾病进展（n=46）、体力状态不佳（n=23）或其他原因（n=10）未接受手术。26 例先接受手术的患者中有 11 例（42%）接受了术后治疗。在接受根治性治疗的患者中，所有接受新辅助治疗的患者的中位总生存期（16.6 个月[范围 2.1 至 142.7 个月]）与主要接受切除术的患者相似（15.1 个月[范围 5.4 至 100.8 个月]），p=0.53。胰腺切除术后，患者院内死亡率为 2%，91%出院回家。
所有接受潜在可切除或边界可切除胰腺癌切除术的 70 岁及以上患者中，85%接受了多模式治疗。超过 90%的患者出院回家。这些数据表明，新辅助治疗在选择老年患者进行手术方面具有一定作用，并支持进一步研究，以制定针对这一高危人群的个体化治疗方案。
