Dimou Francesca, Sineshaw Helmneh, Parmar Abhishek D, Tamirisa Nina P, Jemal Ahmedin, Riall Taylor S
Department of Surgery, University of Arizona, Banner-University Medical Center, 1501 N Campbell Dr, Rm 4327b, PO Box 245131, Tucson, AZ, 85274-5131, USA.
American Cancer Society, Atlanta, GA, USA.
J Gastrointest Surg. 2016 Jan;20(1):93-103; discussion 103. doi: 10.1007/s11605-015-2952-7. Epub 2015 Oct 26.
Pancreatic cancer is considered a systemic disease at presentation. Therefore, multimodality therapy with surgical resection and chemotherapy is the standard of care for locoregional disease. We described treatment patterns and time trends with regard to age and treatment center in the receipt of multimodality therapy.
We used the National Cancer Data Base to identify patients ≥18 years old with stage I and II pancreatic adenocarcinoma. Treatment was defined as no treatment, resection only, chemotherapy only, or multimodality therapy, which consisted of both chemotherapy (neoadjuvant or adjuvant) and resection. Trends in the receipt and type of treatment were compared.
Of 39,441 patients, 22.8% of patients received no treatment, 18.5% received chemotherapy only, 23.0% underwent surgical resection alone, and 35.8% of patients received multimodality therapy. Receipt of multimodality therapy increased from 31.3% in 2004 to 37.9% in 2011 (p < 0.0001). Patients >55 years were less likely to receive multimodality therapy (56-64 years: OR 0.83, 95% CI 0.78-0.89; 65-75: OR 0.60, 95% CI 0.55-0.65; ≥76: OR 0.17, 95% CI 0.16-0.19 compared to patients 18-55). Compared to community hospitals, patients treated at an NCI-designated center were more likely to receive multimodality therapy (OR 1.62, 95% CI 1.46-1.81) and, if they received multimodality therapy, delivery of chemotherapy in the neoadjuvant compared to adjuvant setting (OR 2.82, 95% CI 2.00-3.98).
Despite increased use of multimodality therapy, it remains underutilized in all patients and especially in older patients. Receipt of multimodality therapy and neoadjuvant therapy is highly dependent on treatment at NCI-designated cancer centers.
胰腺癌在确诊时即被视为一种全身性疾病。因此，采用手术切除和化疗的多模式治疗是局部区域性疾病的标准治疗方案。我们描述了在接受多模式治疗方面，年龄和治疗中心的治疗模式及时间趋势。
我们利用国家癌症数据库识别年龄≥18岁的I期和II期胰腺腺癌患者。治疗方式定义为未治疗、仅手术切除、仅化疗或多模式治疗，多模式治疗包括化疗（新辅助化疗或辅助化疗）和手术切除。比较了治疗接受情况和治疗类型的趋势。
在39441例患者中，22.8%的患者未接受治疗，18.5%的患者仅接受化疗，23.0%的患者仅接受手术切除，35.8%的患者接受多模式治疗。多模式治疗的接受率从2004年的31.3%增至2011年的37.9%（p＜0.0001）。年龄＞55岁的患者接受多模式治疗的可能性较小（56 - 64岁：比值比0.83，95%置信区间0.78 - 0.89；65 - 75岁：比值比0.60，95%置信区间0.55 - 0.65；≥76岁：与18 - 55岁患者相比，比值比0.17，95%置信区间0.16 - 0.19）。与社区医院相比，在国立癌症研究所指定中心接受治疗的患者更有可能接受多模式治疗（比值比1.62，95%置信区间1.46 - 1.81），并且，如果他们接受多模式治疗，与辅助化疗相比，新辅助化疗的实施率更高（比值比2.82，95%置信区间2.00 - 3.98）。
尽管多模式治疗的使用有所增加，但在所有患者中，尤其是老年患者中，其使用率仍然较低。多模式治疗和新辅助治疗的接受情况高度依赖于国立癌症研究所指定的癌症中心的治疗。
