Zhu Xiaofei, Shi Dongchen, Li Fuqi, Ju Xiaoping, Cao Yangsen, Shen Yuxin, Cao Fei, Qing Shuiwang, Fang Fang, Jia Zhen, Zhang Huojun
Department of Radiation Oncology, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China.
Department of Pulmonary and Critical Care Medicine, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China.
Cancer Med. 2018 Jul;7(7):2913-2924. doi: 10.1002/cam4.1553. Epub 2018 May 17.
To identify impacts of different combined regimens of stereotactic body radiation therapy (SBRT) and chemotherapy on survival of patients with locally advanced pancreatic cancer (LAPC) and factors correlated with determinations of different combinations. Four hundred and nineteen patients with radiographically and biopsy-proven LAPC were prospectively enrolled. Factors associated with different strategies were analyzed with Chi-square test and contingency coefficients. Cox regression was used to identify factors predictive of survival. Prognostic values of different multimodality were further analyzed by propensity score-matched analysis. Median overall survival (OS) and progression-free survival (PFS) of all patients was 13.2 and 8.2 months, respectively. Baseline ECOG correlated with induction chemotherapy, while tumor stage, lymph node invasion, and toxicity after SBRT associated with adjuvant chemotherapy. Patients with induction chemotherapy alone (12.2 months), adjuvant chemotherapy alone (13.6 months), and induction and adjuvant chemotherapy (13.3 months) had longer OS than those without chemotherapy (11.2 months; P < .001), while adjuvant chemotherapy alone and induction and adjuvant chemotherapy increased PFS. An adjusted overall survival benefit was gained with adjuvant chemotherapy compared with induction and adjuvant chemotherapy (OS: 14.7 months [95% CI: 14.2-15.2 months] vs 13.1 months [95% CI: 12.3-13.9 months]; P < .001) (PFS: 8.8 months [95% CI: 8.4-9.2 months] vs 8.1 months [95% CI: 7.4-8.8 months]; P = .053). Induction and adjuvant chemotherapy, especially adjuvant chemotherapy, plus SBRT may improve OS and PFS. Baseline performance status, tumor stage, lymph node involvement, and toxicity after SBRT influenced determinations of upfront multimodality.
为确定立体定向体部放射治疗（SBRT）与化疗的不同联合方案对局部晚期胰腺癌（LAPC）患者生存的影响以及与不同联合方案决策相关的因素。对419例经影像学和活检证实为LAPC的患者进行前瞻性入组。采用卡方检验和列联系数分析与不同策略相关的因素。使用Cox回归确定生存预测因素。通过倾向评分匹配分析进一步分析不同多模式治疗的预后价值。所有患者的中位总生存期（OS）和无进展生存期（PFS）分别为13.2个月和8.2个月。基线美国东部肿瘤协作组（ECOG）状态与诱导化疗相关，而肿瘤分期、淋巴结侵犯以及SBRT后的毒性与辅助化疗相关。单纯诱导化疗（12.2个月）、单纯辅助化疗（13.6个月）以及诱导和辅助化疗（13.3个月）的患者OS长于未接受化疗的患者（11.2个月；P <.001），而单纯辅助化疗以及诱导和辅助化疗可延长PFS。与诱导和辅助化疗相比，辅助化疗可获得调整后的总生存获益（OS：14.7个月[95%CI：14.2 - 15.2个月] vs 13.1个月[95%CI：12.3 - 13.9个月]；P <.001）（PFS：8.8个月[95%CI：8.4 - 9.2个月] vs 8.1个月[95%CI：7.4 - 8.8个月]；P =.053）。诱导和辅助化疗，尤其是辅助化疗加SBRT可能改善OS和PFS。基线体能状态、肿瘤分期、淋巴结受累情况以及SBRT后的毒性影响初始多模式治疗的决策。
