Hann A, Bohle W, Egger J, Zoller W G
Department of Internal Medicine, Katharinenhospital, Stuttgart, Germany.
Institute for Computer Graphics and Vision, Graz University of Technology, Graz, Austria.
Z Gastroenterol. 2016 Oct;54(10):1138-1142. doi: 10.1055/s-0042-110793. Epub 2016 Oct 10.
New chemotherapeutic strategies for locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) have been shown to improve survival in randomized clinical trials. Little is known about the use of such chemotherapies and their benefit in community-based hospitals. This retrospective study analyzes the overall survival of these patients under "real life conditions" before and after the introduction of FOLFIRINOX in 2011. We retrospectively identified consecutive patients with PDAC who were treated at our hospital from 2011 to June 2014 (2011+ cohort) and 2004 to 2010 (historical cohort). Patients were included if PDAC was diagnosed in a locally advanced or metastatic state and at least 1 cycle of chemotherapy was given. Survival was assessed until April 2016. Patients with FOLFIRINOX were further analyzed regarding drug administration and side effects. 128 patients met the inclusion criteria. Of the 74 patients in the historical cohort, 62 patients received Gemcitabine. Of the 54 patients diagnosed between 2011 and June 2014, 28 patients received FOLFIRINOX and 22 Gemcitabine as the first-line chemotherapy. Only 34 % of the patients in the historical cohort received a second-line chemotherapy in comparison to 69 % in the 2011+ cohort. Median overall survival (OS) showed a survival of 13.1 months (95 % CI; 11.6 - 14.5) for the 2011+ cohort compared to 9.6 months (95 % CI; 6.1 - 13.1) in the historical group. This study shows a marked improvement in survival of patients diagnosed with locally advanced or metastatic PDAC in a community-based hospital during the past 4 years. The most likely reasons are the use of new polychemotherapies like FOLFIRINOX and the use of second-line chemotherapy.
新的针对局部晚期或转移性胰腺导管腺癌（PDAC）的化疗策略已在随机临床试验中显示出可提高生存率。对于此类化疗在社区医院的使用情况及其益处，人们了解甚少。这项回顾性研究分析了2011年引入FOLFIRINOX方案前后，这些患者在“现实生活条件”下的总生存期。我们回顾性地确定了2011年至2014年6月（2011 +队列）以及2004年至2010年（历史队列）在我院接受治疗的连续性PDAC患者。如果PDAC被诊断为局部晚期或转移状态且至少接受了1个周期的化疗，则纳入患者。生存期评估至2016年4月。对接受FOLFIRINOX治疗的患者进一步分析了药物给药情况和副作用。128例患者符合纳入标准。在历史队列的74例患者中，62例接受了吉西他滨治疗。在2011年至2014年6月期间诊断的54例患者中，28例接受FOLFIRINOX作为一线化疗，22例接受吉西他滨作为一线化疗。历史队列中只有34%的患者接受了二线化疗，而2011 +队列中的这一比例为69%。2011 +队列的中位总生存期（OS）为13.1个月（95%CI；11.6 - 14.5），而历史组为9.6个月（95%CI；6.1 - 13.1）。这项研究表明，在过去4年中，社区医院中被诊断为局部晚期或转移性PDAC的患者生存率有显著提高。最可能的原因是使用了像FOLFIRINOX这样的新联合化疗方案以及二线化疗的使用。
