Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706, Santiago de Compostela, Spain.
Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706, Santiago de Compostela, Spain.
BMC Cancer. 2018 May 5;18(1):534. doi: 10.1186/s12885-018-4439-x.
Malnutrition and weight loss are commonly observed in patients with pancreatic cancer and contribute to poor survival. Pancreatic exocrine insufficiency (PEI), which can be caused by ductal obstruction by a tumor, causes maldigestion and malabsorption of nutrients, thus contributing to malnutrition in these patients. In this study, we evaluated the effects of pancreatic enzyme replacement therapy (PERT) on survival in patients with unresectable pancreatic cancer.
A retrospective analysis was conducted on a database of patients with unresectable, pathologically confirmed pancreatic cancer. All patients were evaluated for palliative chemotherapy and received the optimal palliative care. Patients were divided into two groups: Group 1 received standard therapy; Group 2 underwent additional evaluation of the pancreatic function and therapy with PERT, if needed. Survival (median and 95% confidence interval [CI]) was analyzed using Kaplan-Meier and Cox regression; groups were compared using the log-rank test.
Overall, 160 patients with unresectable pancreatic cancer were included in the analysis (mean age: 70.5 years [range 28-100]; gender: 57.5% male; tumor stage: 78.7% Stage IV). Eighty-six patients (53.75%) were in Group 1 and 74 (46.25%) were in Group 2. Age, gender, tumor size, location and stage, weight loss, and serum CA 19-9 were similar between groups. Ninety-three (58.1%) patients received palliative chemotherapy; 46.5% in Group 1 and 71.6% in Group 2 (P < 0.001). Forty-nine (66.2%) patients in Group 2 and none in Group 1 received PERT. Survival in Group 2 (189 days, 95% CI 167.0-211.0 days) was significantly longer than in Group 1 (95.0 days, 95% CI 75.4-114.6 days) (HR 2.117, 95% CI 1.493-3.002; P < 0.001). Chemotherapy and PERT were significantly and independently associated with longer survival in a model controlled by age and tumor stage. In patients with significant weight loss at diagnosis (> 10% bodyweight within 6 months), PERT was associated with longer survival (HR 2.52, 95% CI 1.55-4.11; P < 0.001).
In patients with unresectable pancreatic cancer, PERT in patients with PEI was associated with longer survival compared with those not receiving PERT, especially in those experiencing significant weight loss. This finding should guide future prospective clinical trials of similar interventions.
营养不良和体重减轻在胰腺癌患者中很常见，这与较差的生存状况有关。胰腺外分泌功能不全（PEI）可由肿瘤引起的导管阻塞引起，导致营养物质的消化和吸收不良，从而导致这些患者的营养不良。在这项研究中，我们评估了胰腺酶替代治疗（PERT）对不可切除胰腺癌患者生存的影响。
对不可切除的经病理证实的胰腺癌患者的数据库进行回顾性分析。所有患者均接受姑息性化疗评估，并接受最佳姑息治疗。患者分为两组：组 1 接受标准治疗；组 2 如果需要，对胰腺功能进行额外评估并接受 PERT 治疗。使用 Kaplan-Meier 和 Cox 回归分析生存（中位数和 95%置信区间[CI]）；使用对数秩检验比较组间差异。
共有 160 名不可切除的胰腺癌患者纳入分析（平均年龄：70.5 岁[范围 28-100]；性别：57.5%为男性；肿瘤分期：78.7%为 IV 期）。86 名患者（53.75%）在组 1，74 名患者（46.25%）在组 2。两组间年龄、性别、肿瘤大小、位置和分期、体重减轻和血清 CA 19-9 相似。93 名（58.1%）患者接受姑息化疗；组 1 中有 46.5%，组 2 中有 71.6%（P<0.001）。组 2 中有 49 名（66.2%）患者接受 PERT，组 1 中没有。组 2 的中位生存时间为 189 天（95%CI 167.0-211.0 天），明显长于组 1 的 95.0 天（95%CI 75.4-114.6 天）（HR 2.117，95%CI 1.493-3.002；P<0.001）。在年龄和肿瘤分期控制的模型中，化疗和 PERT 与生存时间延长显著相关。在诊断时体重明显减轻（6 个月内体重减轻>10%）的患者中，PERT 与生存时间延长相关（HR 2.52，95%CI 1.55-4.11；P<0.001）。
在不可切除的胰腺癌患者中，与未接受 PERT 的患者相比，有 PEI 的患者接受 PERT 治疗与生存时间延长相关，特别是在体重明显减轻的患者中。这一发现应该指导未来对类似干预措施的前瞻性临床试验。
