Faluyi Olusola O, Connor Joanna L, Chatterjee Madhuchanda, Ikin Carl, Wong Helen, Palmer Daniel H
Department of Medical Oncology, Clatterbridge Cancer Centre, Bebington, Wirral CH63 4JY, UK.
Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool L69 3BX, UK.
Br J Cancer. 2017 Feb 14;116(4):424-431. doi: 10.1038/bjc.2016.406. Epub 2017 Jan 12.
Previous observations suggest suboptimal 'real world' survival outcomes for advanced pancreatic adenocarcinoma. We hypothesized that centralisation of advanced pancreatic adenocarcinoma management would improve chemotherapy treatment and survival from the disease.
The data was prospectively collected on all cases of advanced pancreatic adenocarcinoma reviewed through Clatterbridge Cancer Centre according to two groups; 1 October 2009-31st Dec 2010 (devolved care) or 1 January 2013-31 March 2014 (centralised care). Analysis included treatment received, 30-day chemotherapy mortality rate and overall survival (OS).
More patients received chemotherapy with central care (67.0% (n=115) vs 43.0% (n=121); P=2.2 × 10) with no difference in 30-day mortality (20.8% vs 25%; P=0.573) but reduced time to commencement of chemotherapy (18 vs 28 days, P=1.0 × 10). More patients received second-line chemotherapy with central care (23.4% vs 1.9%, P=1.4 × 10), while OS was significantly increased with central care (median: Five vs three months, HR 0.785, P=0.045). Exploratory analysis suggested that it was those with a poorer performance status, elderly or with metastatic disease who benefited the most from transition to central care.
A centralised clinic model for advanced pancreatic cancer management resulted in prompt, safe and higher use of chemotherapy compared with devolved care. This was associated with a modest survival benefit. Prospective studies are required to validate the findings reported and the basis for improved survival with centralised care.
既往观察表明，晚期胰腺腺癌患者在“真实世界”中的生存结局欠佳。我们推测，晚期胰腺腺癌管理的集中化将改善化疗治疗及该疾病的生存率。
前瞻性收集了通过克拉特布里奇癌症中心诊治的所有晚期胰腺腺癌病例的数据，分为两组：2009年10月1日至2010年12月31日（分散式医疗）或2013年1月1日至2014年3月31日（集中式医疗）。分析内容包括接受的治疗、30天化疗死亡率和总生存期（OS）。
接受集中式医疗的患者接受化疗的比例更高（67.0%（n = 115）对43.0%（n = 121）；P = 2.2×10），30天死亡率无差异（20.8%对25%；P = 0.573），但化疗开始时间缩短（18天对28天，P = 1.0×10）。接受集中式医疗的患者接受二线化疗的比例更高（23.4%对1.9%，P = 1.4×10），而集中式医疗使总生存期显著延长（中位数：5个月对3个月，HR 0.785，P = 0.045）。探索性分析表明，体能状态较差、老年或有转移性疾病的患者从转为集中式医疗中获益最大。
与分散式医疗相比，晚期胰腺癌管理的集中式诊疗模式能迅速、安全且更多地使用化疗。这与适度的生存获益相关。需要进行前瞻性研究以验证所报告的结果以及集中式医疗改善生存的依据。
