联合化疗对老年转移性胰腺导管腺癌患者的生存获益。

Survival Benefit of Combination Chemotherapy in Elderly Patients With Metastatic Pancreatic Ductal Adenocarcinoma.

机构信息

Division of Medical Oncology.

Albert Einstein College of Medicine, Bronx, NY.

出版信息

Am J Clin Oncol. 2020 Aug;43(8):586-590. doi: 10.1097/COC.0000000000000708.

DOI:10.1097/COC.0000000000000708

PMID:32349022

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7395872/

Abstract

OBJECTIVES

Survival benefit of combination over single-agent chemotherapy for metastatic pancreatic ductal adenocarcinoma (PDAC) was demonstrated in younger patients in clinical trials. The authors aimed to evaluate whether this survival benefit of combination chemotherapy is present in elderly patients with metastatic PDAC.

MATERIALS AND METHODS

The authors identified elderly patients (age 65 y or older) with stage IV PDAC and extracted available clinical information from a prospectively maintained institutional pancreatic cancer registry from 2007 to 2016. The primary endpoint was overall survival. Cox proportional hazards regression was used for multivariable survival analyses. Survival outcomes for the entire cohort and by age group I (elderly, 65 to 75 y) and age group II (very elderly, older than 75 y) were assessed.

RESULTS

A total of 606 patients were included with a median age of 73.8 years. Among them, 239 patients (39%) received combination chemotherapy and 152 patients (25.1%) received single-agent chemotherapy as first-line treatment. Combination chemotherapy was associated with significantly longer median overall survival compared with single-agent chemotherapy (10.9 vs. 7.5 mo, P<0.001) with hazard ratio 0.62 (95% confidence interval, 0.47-0.81; P=0.001) after adjusting for age, sex, comorbidity, Eastern Cooperative Oncology Group (ECOG) performance status, and carbohydrate antigen 19-9 level. Analyses by age groups indicated that very elderly patients (age group II) benefited from combination chemotherapy compared with single-agent chemotherapy with hazard ratio 0.56 (95% confidence interval, 0.31-1; P=0.049), comparable with the age group I (Page-treatment interaction=0.81).

CONCLUSION

Elderly patients, even those older than 75 years, with metastatic PDAC benefited from combination chemotherapy.

摘要

目的

临床试验表明，联合化疗对比单药化疗可为转移性胰腺导管腺癌（PDAC）的年轻患者带来生存获益。本研究旨在评估这种联合化疗的生存获益是否存在于转移性 PDAC 的老年患者中。

材料和方法

本研究纳入了年龄在 65 岁及以上的 IV 期 PDAC 老年患者，并从 2007 年至 2016 年的一个前瞻性维持的机构胰腺癌症登记处中提取了可用的临床信息。主要终点为总生存期。采用 Cox 比例风险回归进行多变量生存分析。评估了整个队列以及年龄组 I（老年，65-75 岁）和年龄组 II（非常老年，大于 75 岁）的生存结局。

结果

共纳入 606 例患者，中位年龄为 73.8 岁。其中，239 例（39%）患者接受了联合化疗，152 例（25.1%）患者接受了单药化疗作为一线治疗。与单药化疗相比，联合化疗的中位总生存期显著延长（10.9 个月 vs. 7.5 个月，P<0.001），调整年龄、性别、合并症、东部肿瘤协作组（ECOG）表现状态和癌抗原 19-9 水平后，风险比为 0.62（95%置信区间，0.47-0.81；P=0.001）。按年龄组分析表明，非常老年患者（年龄组 II）从联合化疗中获益，与单药化疗相比，风险比为 0.56（95%置信区间，0.31-1；P=0.049），与年龄组 I 相似（处理效应检验 P 值=0.81）。