S-1 单药治疗不可切除胰腺癌老年患者的疗效：一项回顾性队列研究。
Efficacy of S-1 monotherapy for older patients with unresectable pancreatic cancer: A retrospective cohort study.
机构信息
Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Japan.
Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Japan.
出版信息
J Geriatr Oncol. 2019 May;10(3):420-426. doi: 10.1016/j.jgo.2018.09.004. Epub 2018 Sep 17.
OBJECTIVES
Pancreatic cancer is a fatal malignancy that frequently occurs in older patients. However, limited evidence is available on the effects of chemotherapy on older patients with unresectable pancreatic cancer. Here we explored the efficacy of S-1, an oral fluorouracil drug, compared with gemcitabine, as first-line chemotherapy.
MATERIALS AND METHODS
We conducted a retrospective cohort study of patients with unresectable pancreatic cancer aged ≥75 years. For this purpose, we used the claims and master databases of the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare between April 1, 2010 to March 31, 2017. According to first-line chemotherapy, we divided patients into gemcitabine and S-1 groups to compare three-year survival from the date of diagnosis and time to second-line chemotherapy as a surrogate indicator of progression-free survival. We analyzed the data using multivariate Cox proportional hazards method.
RESULTS
The study comprised 680 patients, of which 92.5% (N = 629) died within three years of diagnosis. The S-1 group had a significantly lower risk of death within three years of diagnosis (hazard ratio (HR) 0.695, 95% CI: 0. 588-0. 821, p < .001). There were no significant differences (HR 0.968, 95% CI: 0.708-1.324, p = .838) in time to second-line chemotherapy. Two sensitivity analyses excluding study subjects who received radiation therapy or second-line chemotherapy yielded consistent results (HR 0.746, 95% CI: 0.622-0.895, p = .002, HR 0.628, 95% CI: 0. 509-0.776, p < .001, respectively).
CONCLUSION
S-1 can serve as a first-line chemotherapeutic option of patients aged ≥75 years with unresectable pancreatic cancer.
目的
胰腺癌是一种常见于老年患者的致命恶性肿瘤。然而，目前针对不可切除胰腺癌老年患者化疗效果的证据有限。本研究旨在探讨替吉奥（S-1）作为一线化疗药物与吉西他滨相比的疗效。
材料与方法
我们对 2010 年 4 月 1 日至 2017 年 3 月 31 日期间，年龄≥75 岁的不可切除胰腺癌患者进行了回顾性队列研究。根据一线化疗方案，我们将患者分为吉西他滨组和 S-1 组，以比较从诊断日期起的 3 年生存率和二线化疗时间作为无进展生存期的替代指标。我们使用多变量 Cox 比例风险方法分析数据。
结果
该研究共纳入 680 例患者，92.5%（N=629）患者在诊断后 3 年内死亡。S-1 组患者诊断后 3 年内死亡的风险显著降低（风险比（HR）0.695，95%置信区间：0.588-0.821，p<0.001）。二线化疗时间无显著差异（HR 0.968，95%置信区间：0.708-1.324，p=0.838）。排除接受放疗或二线化疗的研究对象进行两项敏感性分析，结果仍一致（HR 0.746，95%置信区间：0.622-0.895，p=0.002；HR 0.628，95%置信区间：0.509-0.776，p<0.001）。
结论
S-1 可作为年龄≥75 岁不可切除胰腺癌患者的一线化疗选择。
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