Oh Tak Kyu, Lee Woo Jin, Woo Sang Myung, Kim Nam Woo, Yim Jiyeon, Kim Dae Hyun
Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Republic of Korea.
Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea.
Pain Physician. 2017 Mar;20(3):E357-E365.
Pain caused by pancreatic cancer (PC) is difficult to control. Celiac plexus neurolysis (CPN) can effectively control the pain and reduce the use of opioids. However, the effect of CPN on survival for patients with unresectable PC remains controversial.
To determine if CPN is associated with survival benefits for these patients.
Retrospective, observational cohort study.
National Cancer Center in Korea.
The CPN group included patients who were diagnosed with unresectable PC and underwent fluoroscopically guided bilateral CPN (10 mL dehydrated alcohol each side) once between January 1, 2006, and December 31, 2013. Patients with PC who did not undergo CPN were in the control group; for the final control group, 1:1 propensity score (PS) matching was conducted with the CPN group. The main outcome was median survival (PC diagnosis to death) after PS matching, assessed using Kaplan-Meier curves.
For the primary overall survival analysis, the CPN and control groups included 110 and 258 patients, respectively. The median survival period was not significantly different between the CPN and control groups (278 vs. 203 days, P = 0.246), even after PS matching (278 vs. 180 days, P = 0.127), or based on time to CPN from diagnosis (≤ 6 vs. > 6 months; 255 vs. 310 days, P = 0.147).
Retrospective design, small sample size, and inconsistent timing of CPN after the diagnosis date.
CPN did not affect survival for patients with unresectable PC. Considering the limitations of the retrospective design, a well-designed prospective design study should be conducted.Key words: Celiac plexus, pancreatic neoplasms, survival, neurolysis, pain, propensity score matching, opioids, cancer.
胰腺癌（PC）所致疼痛难以控制。腹腔神经丛毁损术（CPN）可有效控制疼痛并减少阿片类药物的使用。然而，CPN对不可切除性PC患者生存的影响仍存在争议。
确定CPN是否能使这些患者获得生存益处。
回顾性观察队列研究。
韩国国立癌症中心。
CPN组包括2006年1月1日至2013年12月31日期间被诊断为不可切除性PC且接受过一次透视引导下双侧CPN（每侧10 mL无水乙醇）的患者。未接受CPN的PC患者纳入对照组；对于最终对照组，与CPN组进行1:1倾向评分（PS）匹配。主要结局是PS匹配后的中位生存期（从PC诊断至死亡），采用Kaplan-Meier曲线进行评估。
对于主要的总生存分析，CPN组和对照组分别包括110例和258例患者。CPN组和对照组的中位生存期无显著差异（278天对203天，P = 0.246），PS匹配后（278天对180天，P = 0.127）或根据从诊断至CPN的时间（≤6个月对>6个月；255天对310天，P = 0.147）亦是如此。
回顾性设计、样本量小以及诊断日期后CPN的时间不一致。
CPN对不可切除性PC患者的生存无影响。考虑到回顾性设计的局限性，应开展设计良好的前瞻性研究。关键词：腹腔神经丛、胰腺肿瘤、生存、毁损术、疼痛、倾向评分匹配、阿片类药物、癌症
