切除的胰腺癌患者对指南建议的依从性高，但辅助化疗完成率低：一项队列研究。
High compliance with guideline recommendations but low completion rates of adjuvant chemotherapy in resected pancreatic cancer: A cohort study.
作者信息
Weinrich Malte, Bochow Johanna, Kutsch Anna-Lisa, Alsfasser Guido, Weiss Christel, Klar Ernst, Rau Bettina M
机构信息
Department of General, Thoracic, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany.
Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Germany.
出版信息
Ann Med Surg (Lond). 2018 Jun 27;32:32-37. doi: 10.1016/j.amsu.2018.06.004. eCollection 2018 Aug.
BACKGROUND
Adjuvant chemotherapy (adCx) is an integral part of multimodal treatment in resected pancreatic ductal adenocarcinoma (PDAC) and is recommended by the German S3 guideline since 2007 in all patients. We aimed to investigate the impact of this guideline at our institution.
METHODS
In 151 of 403 pancreatic resections performed histopathology revealed PDAC. Follow-up data were available from 143 patients (95%) representing our study group. The rate of recommended, initiated and fully completed adCx was analyzed for period 1 (09/2003-07/2007) and period 2 (08/2007-08/2014).
RESULTS
Our study group comprised 49 patients in period 1 and 94 patients in period 2. AdCx was recommended, initiated and completed in 42/49 (86%), 34/49 (69%) and 22/49 (45%) patients in period 1 and in 93/94 (99%), 78/94 (83%) and 49/94 (52%) patients in period 2, respectively. Only the increase in recommendations for adCx was statistically significant (p = 0.0024). Overall, only 50% (71/143) of patients fully completed the Cx protocol. Completed adCx resulted in a significantly longer (p = 0.0225) overall survival compared to patients with incomplete or without adCx. Multiple logistic regression revealed adCx (p = 0.0046) as independent factor of survival. The hazard ratio for fully completed adCx was 0.406 and for incomplete adCx 0.567.
CONCLUSION
Our results indicate a high acceptance of the S3-guidline recommendation for adCx in resected PDAC in a routine setting, which, however, is completed in only 50% of all patients. Fully completed adCx had the most powerful effect on improving overall survival.
背景
辅助化疗（adCx）是切除性胰腺导管腺癌（PDAC）多模式治疗的一个组成部分，自2007年以来德国S3指南建议所有患者均接受辅助化疗。我们旨在研究该指南在我们机构的影响。
方法
在403例胰腺切除术中，151例经组织病理学检查确诊为PDAC。143例患者（95%）有随访数据，构成我们的研究组。分析了第1阶段（2003年9月 - 2007年7月）和第2阶段（2007年8月 - 2014年8月）推荐、开始并完全完成辅助化疗的比例。
结果
我们的研究组在第1阶段有49例患者，第2阶段有94例患者。第1阶段分别有42/49（86%）、34/49（69%）和22/49（45%）的患者被推荐、开始并完成辅助化疗，第2阶段分别有93/94（99%）、78/94（83%）和49/94（52%）的患者。只有辅助化疗推荐比例的增加具有统计学意义（p = 0.0024）。总体而言，只有50%（71/143）的患者完全完成了化疗方案。与未完成或未接受辅助化疗的患者相比，完成辅助化疗的患者总生存期显著延长（p = 0.0225）。多因素逻辑回归显示辅助化疗（p = 0.0046）是生存的独立因素。完全完成辅助化疗的风险比为0.406，未完成辅助化疗的风险比为0.567。
结论
我们的结果表明，在常规情况下，S3指南对切除性PDAC辅助化疗的推荐接受度较高，但只有50%的患者完成了治疗。完全完成辅助化疗对提高总生存期的效果最为显著。
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