Terashima Takeshi, Yamashita Tatsuya, Sakai Akito, Ohta Hajime, Hinoue Yoshinobu, Toya Daisyu, Kawai Hiroshi, Yonejima Manabu, Urabe Takeshi, Noda Yatsugi, Mizukoshi Eishiro, Kaneko Shuichi
Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
Department of Internal Medicine (Gastroenterology), Toyama Prefectural Central Hospital, Toyama, Japan.
Jpn J Clin Oncol. 2018 Nov 1;48(11):966-973. doi: 10.1093/jjco/hyy132.
FOLFIRINOX (FFX) and gemcitabine (GEM) plus nab-paclitaxel (GnP) have recently been available for treating pancreatic ductal adenocarcinoma (PDAC). We investigated trends in characteristics, treatment and outcomes of unselected patients with unresectable PDAC in real-life practice in Japan.
We retrospectively reviewed the medical records of 1085 patients diagnosed as having unresectable or recurrent PDAC in multiple centers in the Hokuriku area between January 2009 and July 2015.
The incidence of pathologically proven PDAC had increased from 18.7% in 2009 to 56.2% in 2015. Oncological therapy was administered to 779 patients (71.8%): chemotherapy (n = 675), chemo-radiotherapy (n = 92) or radiotherapy (n = 12); the remaining patients were treated with best supportive care. Of 100 patients diagnosed in 2009, 62.0% received GEM as first-line chemotherapy; whereas 30.7% of the 75 patients diagnosed in 2015 received FFX, 25.3% GnP, 22.7% GEM and 17.3% S-1. The objective response rates of patients treated with FFX, GnP and GEM were 14.9%, 35.0% and 5.5%, respectively and the OS 10.3, 9.9 and 7.5 months after FFX, GnP and GEM, respectively. Grade 3 or greater any hematological toxicity occurred in 70.2%, 70.0% and 18.8% of the patients treated with FFX, GnP and GEM, respectively. The reasons for treatment discontinuation were adverse events in 9.8%, 26.7% and 24.1% of the patients treated with FFX, GnP and GEM, respectively.
Chemotherapeutic protocols changed dramatically between 2009 and 2015. Continuous collection and analysis for our cohort with longer follow-up provides useful information about treatment selection and prediction of outcome.
FOLFIRINOX（FFX）和吉西他滨（GEM）联合纳米白蛋白结合型紫杉醇（GnP）最近已可用于治疗胰腺导管腺癌（PDAC）。我们调查了日本实际临床中未经选择的不可切除PDAC患者的特征、治疗及预后趋势。
我们回顾性分析了2009年1月至2015年7月间在北陆地区多个中心诊断为不可切除或复发PDAC的1085例患者的病历。
经病理证实的PDAC发病率从2009年的18.7%增至2015年的56.2%。779例患者（71.8%）接受了肿瘤治疗：化疗（n = 675）、放化疗（n = 92）或放疗（n = 12）；其余患者接受最佳支持治疗。2009年诊断的100例患者中，62.0%接受GEM作为一线化疗；而2015年诊断的75例患者中，30.7%接受FFX，25.3%接受GnP，22.7%接受GEM，17.3%接受S-1。接受FFX、GnP和GEM治疗的患者客观缓解率分别为14.9%、35.0%和5.5%，接受FFX、GnP和GEM治疗后的总生存期分别为10.3个月、9.9个月和7.5个月。接受FFX、GnP和GEM治疗的患者中，分别有70.2%、70.0%和18.8%发生3级或更高级别的血液学毒性。接受FFX、GnP和GEM治疗的患者中，分别有9.8%、26.7%和24.1%因不良事件而停止治疗。
2009年至2015年间化疗方案发生了显著变化。对我们队列进行持续更长时间的随访收集和分析可为治疗选择及预后预测提供有用信息。
