Digestive Oncology, Reims University Hospital, Reims, France.
Research and Public Health, Reims University Hospital, Reims, France.
Dig Liver Dis. 2020 Jun;52(6):658-667. doi: 10.1016/j.dld.2020.03.014. Epub 2020 Apr 30.
The effect of treatment delay on survival in pancreatic ductal adenocarcinoma (PDAC) remains unclear.
This study aimed to assess the prognostic impact of time to diagnosis and chemotherapy in advanced PDAC and factors influencing the time intervals.
advanced PDAC patients receiving chemotherapy in five centers in the decade 2007-2016 were included. Key time points during care pathway from clinical presentation to beginning of chemotherapy were retrospectively collected. Multivariate Cox proportional hazard model was performed.
A total of 409 patients were included (mean age 66.1 ± 10.3 years; 250 metastatic (61%); 139 received FOLFIRINOX chemotherapy (34%). The median overall survival (OS) was 7.2 months. The median times from first symptoms and from first specialist visit to the beginning of chemotherapy were respectively 100 days and 47 days. None of time intervals was significantly associated with OS. Significant prognostic factors were FOLFIRINOX chemotherapy (HR 0.6 [0.5-0.8]; P < 0.001), metastasis (HR 1.6 [1.3-2.0]; P = 0.001), WHO PS ≥ 2 (HR 1.6 [1.2-2.1]; P < 0.001) and acute pancreatitis as first symptom (HR 2.9 [1.7-4.9]; P < 0.001). Jaundice shortened time to diagnosis (P < 0.001). Acute pancreatitis (P < 0.001) and diabetes (P = 0.01) increased time to treatment.
Wait times from clinical presentation to beginning of chemotherapy do not influence survival in advanced PDAC.
治疗延迟对胰腺导管腺癌（PDAC）患者生存的影响仍不清楚。
本研究旨在评估诊断和化疗后晚期 PDAC 患者的生存预后，并分析影响时间间隔的因素。
纳入了 2007 年至 2016 年期间在五个中心接受化疗的晚期 PDAC 患者。回顾性收集了从临床症状出现到开始化疗的关键时间点。采用多因素 Cox 比例风险模型进行分析。
共纳入 409 例患者（平均年龄 66.1 ± 10.3 岁；250 例为转移性疾病[61%]；139 例接受 FOLFIRINOX 化疗[34%]）。中位总生存期（OS）为 7.2 个月。首次出现症状至首次专科就诊的中位时间分别为 100 天和 47 天。这些时间间隔与 OS 均无显著相关性。有意义的预后因素包括 FOLFIRINOX 化疗（HR 0.6 [0.5-0.8]；P < 0.001）、转移（HR 1.6 [1.3-2.0]；P = 0.001）、美国东部肿瘤协作组（ECOG）体力状态评分（PS）≥2（HR 1.6 [1.2-2.1]；P < 0.001）和首发症状为急性胰腺炎（HR 2.9 [1.7-4.9]；P < 0.001）。黄疸缩短了诊断时间（P < 0.001）。急性胰腺炎（P < 0.001）和糖尿病（P = 0.01）增加了治疗时间。
从临床症状出现到开始化疗的时间间隔不会影响晚期 PDAC 患者的生存。
