Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Ann Surg Oncol. 2017 Aug;24(8):2387-2396. doi: 10.1245/s10434-017-5880-9. Epub 2017 May 22.
National Cancer Database analysis showed 70% of patients with stage I pancreatic adenocarcinoma (PDA) did not have surgery. We sought to analyze adherence to expected treatment (ET) by stage for PDA and identify factors that led to no treatment (NT) or unexpected treatment (UT) in a recent cohort.
Using our Institutional Cancer Registry (ICR), we identified patients with PDA from 2004 to 2013. ET was defined as surgery ± chemotherapy ± radiation for stages I and II, chemotherapy ± radiation for stage III, and chemotherapy for stage IV, while UT was defined as no surgery for stages I and II, surgery for stage III, or ± surgery ± XRT for stage IV.
Overall, 2340 patients were identified (stages I and II = 51%, stage III = 11%, stage IV = 38%; ET = 58%, UT = 18%, NT = 24%). A total of 1183 patients had resectable PDA (stages I and II; ET = 57%, UT = 27%, NT = 16%), with ET demonstrating the best overall survival, but UT showing better survival than NT (p < 0.0001). In addition, 261 patients had unresectable PDA (stage III; ET = 69%, UT = 12%, NT = 18%), and survival was best in UT, but ET had a survival advantage over NT (p < 0.0001). Finally, 896 patients had metastatic PDA (stage IV; ET = 55%; UT = 9%; NT = 36%), with the NT group showing worse survival than the ET and UT groups (p < 0.0001).
Unlike previous reports, most patients with early-stage disease had ET. ET and UT were associated with better survival than NT in all stages, and surgical cohorts have improved survival regardless of stage. Younger age, male sex, white race, and less comorbidity were predictors of receiving treatment.
国家癌症数据库分析显示，70%的 I 期胰腺腺癌（PDA）患者未接受手术。我们试图分析最近一组患者中各期别接受预期治疗（ET）的情况，并确定导致未治疗（NT）或意外治疗（UT）的因素。
利用我们的机构癌症登记处（ICR），我们从 2004 年至 2013 年期间确定了患有 PDA 的患者。ET 定义为 I 期和 II 期行手术+化疗+放疗，III 期行化疗+放疗，IV 期行化疗；UT 定义为 I 期和 II 期不行手术，III 期行手术，或 IV 期行手术+XRT。
总体而言，共确定了 2340 名患者（I 期和 II 期占 51%，III 期占 11%，IV 期占 38%；ET 占 58%，UT 占 18%，NT 占 24%）。共有 1183 名患者患有可切除的 PDA（I 期和 II 期；ET 占 57%，UT 占 27%，NT 占 16%），ET 显示出最佳的总体生存率，但 UT 比 NT 显示出更好的生存率（p<0.0001）。此外，261 名患者患有不可切除的 PDA（III 期；ET 占 69%，UT 占 12%，NT 占 18%），UT 的生存率最好，但 ET 比 NT 有生存优势（p<0.0001）。最后，896 名患者患有转移性 PDA（IV 期；ET 占 55%；UT 占 9%；NT 占 36%），NT 组的生存率明显差于 ET 和 UT 组（p<0.0001）。
与之前的报告不同，大多数早期疾病患者接受了 ET。在所有阶段，ET 和 UT 与 NT 相比均与更好的生存率相关，且无论分期如何，手术队列的生存率都有所提高。年龄较小、男性、白种人和较少合并症是接受治疗的预测因素。
