术前手术切除后完成辅助化疗在胰腺癌中并不常见，但与改善生存有关。
Completion of Adjuvant Chemotherapy After Upfront Surgical Resection for Pancreatic Cancer Is Uncommon Yet Associated With Improved Survival.
机构信息
Division of Surgical Oncology, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
出版信息
Ann Surg Oncol. 2019 Nov;26(12):4108-4116. doi: 10.1245/s10434-019-07602-6. Epub 2019 Jul 16.
BACKGROUND
Multiple trials have demonstrated a survival benefit for adjuvant chemotherapy after resection of pancreatic adenocarcinoma. This study aimed to identify the rate for completion of adjuvant chemotherapy, factors associated with completion, and its impact on survival after surgical resection.
METHODS
The Surveillance Epidemiology and End Results Medicare-linked data was used to identify patients who underwent upfront resection for pancreatic adenocarcinoma from 2004 to 2013. Billing codes were used to quantify receipt and completion of chemotherapy. Factors associated with completion of chemotherapy were identified using multivariable regression. Kaplan-Meier and Cox proportional-hazards modeling were used to examine survival.
RESULTS
The inclusion criteria were met by 2440 patients. Of these patients, 65% received no adjuvant chemotherapy, 28% received incomplete therapy, and 7% completed chemotherapy. The factors associated with chemotherapy completion were nodal metastases and treatment at a National Cancer Institute-designated cancer center (p ≤ 0.05). Comorbidities decreased the odds of completion (p ≤ 0.05). The median overall survival (OS) was 14 months for the patients who received no adjuvant chemotherapy, 17 months for those who received incomplete adjuvant chemotherapy, and 22 months for those who completed adjuvant chemotherapy (p ≤ 0.05). More recent diagnosis, comorbidities, T stage, nodal metastases, and no adjuvant chemotherapy were associated with an increased hazard ratio for death (p ≤ 0.05). Evaluation of 15 or more nodes and completion of chemotherapy decreased the hazard ratio for death (p ≤ 0.05).
CONCLUSIONS
Only 7% of the Medicare patients who underwent upfront resection for pancreatic cancer completed adjuvant chemotherapy, yet completion of adjuvant chemotherapy was associated with improved OS. Completion of adjuvant chemotherapy should be the goal after upfront resection, but neoadjuvant chemotherapy may ensure that patients receive systemic chemotherapy.
背景
多项试验表明，在胰腺腺癌切除术后进行辅助化疗可提高生存率。本研究旨在确定完成辅助化疗的比率、与完成相关的因素及其对手术切除后生存的影响。
方法
使用监测、流行病学和最终结果（SEER）-医疗保险链接数据，确定 2004 年至 2013 年间接受胰腺腺癌直接切除术的患者。使用计费代码来量化化疗的接受和完成情况。使用多变量回归确定与化疗完成相关的因素。使用 Kaplan-Meier 和 Cox 比例风险模型来检查生存情况。
结果
共有 2440 例患者符合纳入标准。其中，65%的患者未接受辅助化疗，28%的患者接受了不完全治疗，7%的患者完成了化疗。与化疗完成相关的因素是淋巴结转移和在国家癌症研究所指定的癌症中心治疗（p≤0.05）。合并症降低了完成的可能性（p≤0.05）。未接受辅助化疗的患者中位总生存期（OS）为 14 个月，接受不完全辅助化疗的患者为 17 个月，接受辅助化疗的患者为 22 个月（p≤0.05）。较晚的诊断、合并症、T 分期、淋巴结转移和未接受辅助化疗与死亡风险比增加相关（p≤0.05）。评估 15 个或更多淋巴结和完成化疗降低了死亡风险比（p≤0.05）。
结论
仅有 7%的接受胰腺腺癌直接切除术的 Medicare 患者完成了辅助化疗，但完成辅助化疗与改善 OS 相关。完成辅助化疗应是直接切除术后的目标，但新辅助化疗可能确保患者接受全身化疗。
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