Blaszak Michael, El-Masri Maher, Hirmiz Khalid, Mathews John, Omar Abeer, Elfiki Tarek, Gupta Rasna, Hamm Caroline, Kanjeekal Sindu, Kay Amin, Kulkarni Swati, Ghafoor Akmal
Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada.
Faculty of Nursing, University of Windsor, Windsor, Ontario, ON N9B 3P4, Canada.
Mol Clin Oncol. 2017 Apr;6(4):583-588. doi: 10.3892/mco.2017.1179. Epub 2017 Mar 1.
The present retrospective chart review examined the overall survival (OS) of patients with pancreatic ductal adenocarcinoma based on the disease stage in a sample of 296 patients with pancreatic cancer. Secondary outcome measurements included OS in chemotherapy vs. supportive treatment groups among metastatic patients, OS based on response to chemotherapy among metastatic patients, and OS and disease free survival (DFS) in surgically resected disease with vs. without adjuvant therapy. Data were analyzed using Kaplan-Meier and multivariate cox-regression analyses based on a 95% confidence interval (CI) or an α-value of 0.05. OS was significantly different based on the disease stage, with 3.63 (95% CI, 2.84-4.43), 6.57 (95% CI, 4.06-9.08) and 15.57 (95% CI, 11.79-19.35) months in the advanced, locally advanced, and localized disease groups, respectively. OS was higher in metastatic-stage patients who received chemotherapy [6.07 months (95% CI, 4.75-7.39)] compared with those who received supportive therapy alone [2.50 months (95% CI, 2.16-2.84; P<.001)]. Metastatic-stage patients with partial or stable response to chemotherapy had higher OS [10.53 months (95% CI, 6.35-14.72)] in comparison with those with progression [6.33 months (95% CI, 5.79-6.88)] or an undocumented response [3.30 months (95% CI, 1.76-4.84; P<0.001)]. In patients who underwent surgical resection of localized disease, adjuvant therapy increased the adjusted OS and DFS as compared with surgical excision alone (P=0.013; 95% CI, 0.278-0.862). Positive margins reduced OS [hazard ratio (HR) 2.670; 95% CI, 1.467-4.860]. The present single-site study has demonstrated that OS may markedly differ on the basis of the disease status at the time of diagnosis. Metastatic-stage patients with stable or partial response to chemotherapy had an increased OS, as did surgical patients with localized disease who received adjuvant treatment, after adjusting for margin status.
本回顾性图表审查基于疾病分期,对296例胰腺癌患者样本中胰腺导管腺癌患者的总生存期(OS)进行了研究。次要结局指标包括转移性患者化疗组与支持治疗组的OS、转移性患者基于化疗反应的OS,以及接受与未接受辅助治疗的手术切除疾病患者的OS和无病生存期(DFS)。基于95%置信区间(CI)或α值为0.05,使用Kaplan-Meier和多变量cox回归分析对数据进行分析。基于疾病分期,OS有显著差异,晚期、局部晚期和局限性疾病组的OS分别为3.63(95%CI,2.84 - 4.43)、6.57(95%CI,4.06 - 9.08)和15.57(95%CI,11.79 - 19.35)个月。接受化疗的转移性阶段患者的OS[6.07个月(95%CI,4.75 - 7.39)]高于仅接受支持治疗的患者[2.50个月(95%CI,2.16 - 2.84;P<0.001)]。化疗部分缓解或病情稳定的转移性阶段患者的OS[10.53个月(95%CI,6.35 - 14.72)]高于病情进展[6.33个月(95%CI,5.79 - 6.88)]或反应未记录的患者[3.30个月(95%CI),1.76 - 4.84;P<0.001)]。在接受局限性疾病手术切除的患者中,与单纯手术切除相比,辅助治疗增加了调整后的OS和DFS(P = 0.013;95%CI,0.278 - 0.862)。切缘阳性降低了OS[风险比(HR)2.670;95%CI,1.467 - 4.860]。本单中心研究表明,根据诊断时的疾病状态,OS可能有显著差异。在调整切缘状态后,化疗反应稳定或部分缓解的转移性阶段患者以及接受辅助治疗的局限性疾病手术患者的OS有所增加。