Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA.
HPB (Oxford). 2020 Nov;22(11):1542-1548. doi: 10.1016/j.hpb.2020.03.006. Epub 2020 Apr 13.
Adjuvant chemotherapy (AC) is associated with improved survival following resection of pancreatic adenocarcinoma but is frequently delayed or deferred due to perioperative complications or patient deconditioning. The aim of this study was to assess impact of delayed AC on overall survival after pancreaticoduodenectomy for pancreatic head adenocarcinoma.
Patients with stage I-III pancreatic head adenocarcinoma in the 2006-2015 National Cancer Database were grouped by timing of AC (<6-weeks, 6-12-weeks, and 12-24-weeks). Overall survival was compared using Cox proportional hazard models adjusting for patient, tumor, and hospital factors. Subgroup analyses were conducted to assess the impact of comorbidities, readmission or extended hospital stay, and receipt of single- versus multi-agent chemotherapy.
Of 13438 patients, 4552 (33.9%) received no AC, 2112 (15.7%) received AC <6-weeks following resection, 5580 (41.5%) within 6-12 weeks, and 1194 (8.9%) within 12-24 weeks. AC was associated with improved overall survival (adjusted hazard ratio [HR] <6-weeks: 0.765, 6-12-weeks: 0.744, and 12-24-weeks: 0.736 (p < 0.001)). This survival advantage persisted for patients with comorbidities, those with postoperative complications, and in those receiving single- or multi-agent regimens.
For patients with stage I-III pancreatic adenocarcinoma, receipt of AC is associated with improved overall survival, even if delayed up to 24-weeks.
辅助化疗（AC）可改善胰腺腺癌切除术后的生存，但由于围手术期并发症或患者身体状况恶化，AC 常被延迟或推迟。本研究旨在评估胰腺头腺癌胰十二指肠切除术后 AC 延迟对总生存的影响。
在 2006 年至 2015 年国家癌症数据库中，根据 AC 的时间（<6 周、6-12 周和 12-24 周）将 I-III 期胰腺头腺癌患者分组。使用 Cox 比例风险模型比较总生存情况，该模型调整了患者、肿瘤和医院因素。进行亚组分析以评估合并症、再入院或延长住院时间以及接受单药与多药化疗的影响。
在 13438 例患者中，4552 例（33.9%）未接受 AC，2112 例（15.7%）在切除术后<6 周内接受 AC，5580 例（41.5%）在 6-12 周内接受 AC，1194 例（8.9%）在 12-24 周内接受 AC。AC 与总体生存改善相关（调整后的风险比<6 周：0.765，6-12 周：0.744，12-24 周：0.736（p<0.001））。这种生存优势在合并症患者、术后并发症患者以及接受单药或多药方案的患者中持续存在。
对于 I-III 期胰腺腺癌患者，即使延迟至 24 周，接受 AC 治疗仍与总体生存改善相关。
