Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Division of Hematology-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Cancer Med. 2019 Sep;8(12):5554-5563. doi: 10.1002/cam4.2483. Epub 2019 Aug 6.
We previously developed a robust prognostic model (GS model) to predict the survival outcome of patients with advanced pancreatic cancer (APC) receiving palliative chemotherapy with gemcitabine plus S-1 (GS). This study aimed to validate the application of the GS model in APC patients receiving chemotherapy other than the GS regimen.
We retrospectively analyzed 727 APC patients who received first-line palliative chemotherapy other than the GS regimen between 2010 and 2016 at four institutions in Taiwan. The patients were categorized into three prognostic groups based on the GS model for comparisons of survival outcome, best tumor response, and in-group survival differences with monotherapy or combination therapy.
The median survival times for the good, intermediate, and poor prognostic groups were 13.4, 8.4, and 4.6 months, respectively. The hazard ratios for the comparisons of intermediate and poor to good prognostic groups were 1.51 (95% confidence interval [CI]), 1.22-1.88, P < .001) and 2.84 (95% CI, 2.34-3.45, P < .001). The best tumor responses with either partial response or stable disease were 57.5%, 40.4%, and 17.2% of patients in the good, intermediate, and poor prognostic groups (P < .001), respectively. For patients in the good prognostic group, first-line chemotherapy with monotherapy and combination therapy had similar median survival times (13.8 vs 12.9 months, P = .26), while combination therapy showed a better median survival time than monotherapy in patients in the intermediate and poor prognostic groups (8.5 vs 8.0 months, P = .038 and 5.7 vs 3.7 months, P = .001, respectively).
The results of our study supported the application of the GS model as a general prognostic tool for patients with pancreatic cancer receiving first-line palliative chemotherapy with gemcitabine-based regimens.
我们之前开发了一个强大的预后模型（GS 模型），用于预测接受吉西他滨加 S-1（GS）姑息化疗的晚期胰腺癌（APC）患者的生存结果。本研究旨在验证 GS 模型在接受非 GS 方案化疗的 APC 患者中的应用。
我们回顾性分析了 2010 年至 2016 年在台湾四家机构接受非 GS 方案一线姑息化疗的 727 例 APC 患者。根据 GS 模型将患者分为三个预后组，比较生存结果、最佳肿瘤反应以及单药或联合治疗的组内生存差异。
良好、中等和差预后组的中位生存时间分别为 13.4、8.4 和 4.6 个月。中间和差预后组与良好预后组比较的风险比分别为 1.51（95%置信区间 [CI]）、1.22-1.88，P<.001）和 2.84（95%CI，2.34-3.45，P<.001）。具有部分缓解或稳定疾病的最佳肿瘤反应在良好、中等和差预后组中的患者分别为 57.5%、40.4%和 17.2%（P<.001）。对于良好预后组的患者，单药和联合治疗的一线化疗具有相似的中位生存时间（13.8 与 12.9 个月，P=.26），而对于中等和差预后组的患者，联合治疗的中位生存时间优于单药治疗（8.5 与 8.0 个月，P=.038 和 5.7 与 3.7 个月，P=.001）。
我们的研究结果支持将 GS 模型作为接受吉西他滨为基础方案一线姑息化疗的胰腺癌患者的一般预后工具的应用。
