From the Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal Infirmary, Manchester University Hospitals Foundation Trust.
Department of Medical Oncology, The Christie NHS Foundation Trust.
Pancreas. 2020 Feb;49(2):201-207. doi: 10.1097/MPA.0000000000001486.
The aim of the study was to determine the impact of age on curative management and outcomes of patients with pancreatic ductal adenocarcinoma.
Patients who underwent resection for pancreatic ductal adenocarcinoma at 2 units were retrospectively reviewed (between 2005 and 2017) and stratified by age (older patients ≥70 years). Regression analysis was used to explore factors impacting administration of adjuvant chemotherapy and survival. The Kaplan-Meier method was used to estimate overall survival (time from surgery to death). Statistical significance was set at P < 0.05.
From 2005 to 2014, 222 patients were identified (<70 years, n = 128; ≥70 years, n = 94). Elderly patients were less likely to receive adjuvant chemotherapy compared with younger patients (odds ratio, 0.57, P = 0.041). Tumor stage, margin, and year of surgery (post-2011 vs pre-2011) were not predictors for chemotherapy receipt (P > 0.05). Frailty was the commonest reason (36.8%) to decline chemotherapy in elderly patients. In patients receiving adjuvant chemotherapy, completion rates (P = 0.32) and overall survival (24 months vs 30 months, P = 0.50) were no different.
Elderly patients demonstrate similar outcomes to younger yet are less likely to commence chemotherapy because of frailty. Holistic preoperative assessment may improve selection for curative treatment.
本研究旨在探讨年龄对胰腺导管腺癌患者治疗管理和结局的影响。
回顾性分析 2 个单位接受胰腺导管腺癌切除术的患者（2005 年至 2017 年期间），并按年龄分层（年龄较大的患者≥70 岁）。回归分析用于探讨影响辅助化疗和生存的因素。采用 Kaplan-Meier 法估计总生存率（从手术到死亡的时间）。P<0.05 为统计学显著性差异。
2005 年至 2014 年期间，共确定了 222 名患者（年龄<70 岁，n=128；年龄≥70 岁，n=94）。与年轻患者相比，老年患者接受辅助化疗的可能性较低（优势比，0.57，P=0.041）。肿瘤分期、切缘和手术年份（2011 年后与 2011 年前）不是接受化疗的预测因素（P>0.05）。虚弱是老年患者拒绝化疗的最常见原因（36.8%）。在接受辅助化疗的患者中，完成率（P=0.32）和总生存率（24 个月与 30 个月，P=0.50）无差异。
与年轻患者相比，老年患者的结局相似，但由于虚弱，接受化疗的可能性较低。全面的术前评估可能有助于选择治愈性治疗。
