Kasumova Gyulnara G, Eskander Mariam F, de Geus Susanna W L, Neto Mario Matiotti, Tabatabaie Omidreza, Ng Sing Chau, Miksad Rebecca A, Mahadevan Anand, Rodrigue James R, Tseng Jennifer F
Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Surgery. 2017 Aug;162(2):275-284. doi: 10.1016/j.surg.2017.03.009. Epub 2017 May 6.
Survival in pancreatic cancer remains poor with curative potential dependent on operative resection. We reviewed national adherence to practice guidelines to evaluate regional variation in the treatment and survival of patients with pancreatic cancer.
Retrospective cohort review of adults with pancreatic adenocarcinoma using the National Cancer Data Base from 2006 to 2013. Overall survival was compared by the Kaplan-Meier method and Cox proportional hazards models. Sequential multivariate logistic regression models were generated for odds of: a) diagnosis in stage I/II, b) resection, and c) receipt of multimodality therapy, defined as operative resection plus chemotherapy with or without radiation. Five geographic regions of the United States were used for analyses.
A total of 115,952 patients were identified. At least 22% of patients in all stages received no treatment, with only 38.4% and 32.3% of stage I and II patients receiving multimodality therapy. On unadjusted analysis, the Northeast had the greatest survival for all stages of disease, most pronounced for stage I where patients lived 2 to 3 more months (log-rank P < .0001). While adjusted odds of early diagnosis and resection were comparable or greater across regions relative to the Northeast, patients who underwent resection in the Northeast were significantly more likely to receive multimodality therapy. Multivariate Cox modeling for patients receiving multimodality therapy accounted for differences in 3 of 4 remaining regions.
Regional variations exist in pancreatic cancer treatment and survival. While providing multimodality cancer-directed therapy can help mitigate these differences, survival with pancreatic cancer needs to be interpreted in the context of overall health, underlying risk factors, and life expectancy.
胰腺癌患者的生存率仍然很低，其治愈潜力取决于手术切除。我们回顾了全国对实践指南的遵循情况，以评估胰腺癌患者治疗和生存的地区差异。
使用2006年至2013年的国家癌症数据库对成年胰腺腺癌患者进行回顾性队列研究。采用Kaplan-Meier法和Cox比例风险模型比较总生存率。针对以下情况的几率生成顺序多变量逻辑回归模型：a）I/II期诊断，b）切除，c）接受多模式治疗，定义为手术切除加化疗（有或无放疗）。美国的五个地理区域用于分析。
共识别出115,952例患者。所有阶段至少22%的患者未接受治疗，I期和II期患者中分别只有38.4%和32.3%接受了多模式治疗。未经调整的分析显示，东北部所有疾病阶段的生存率最高，I期最为明显，患者多活2至3个月（对数秩检验P <.0001）。虽然相对于东北部，各地区早期诊断和切除的调整后几率相当或更高，但在东北部接受切除的患者更有可能接受多模式治疗。对接受多模式治疗的患者进行多变量Cox建模，解释了其余4个地区中3个地区的差异。
胰腺癌的治疗和生存存在地区差异。虽然提供多模式癌症导向治疗有助于减轻这些差异，但胰腺癌的生存情况需要结合整体健康状况、潜在风险因素和预期寿命来解读。
