Department of Radiation Oncology, David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Cancer Med. 2020 Jul;9(13):4572-4580. doi: 10.1002/cam4.3081. Epub 2020 May 5.
Evidence-based recommendations on duration of multiagent systemic therapy for LAPC are lacking. Herein, we assess the impact of duration of combination systemic therapy on survival of patients with LAPC.
The National Cancer Database was interrogated to identify patients with untreated LAPC diagnosed from 2004 to 2014. Patients treated with ≥ 1 month of multiagent chemotherapy (MAC) and ≥ 6 months of follow-up were included. Kaplan-Meier survival curves were generated to examine OS of each MAC duration group. Univariable and multivariable Cox proportional hazards regression was used to examine the association between OS with demographic and clinical variables. Statistical computations were performed using SAS Software Version 9.4.
Of the 3410 patients, 1114 met inclusion criteria. Median age was 64 years. Median treatment duration was 3.2 months (range 1-19.8). Median follow-up was 23.5 months (range 3-120). Median OS of all patients was 9.4 months (95% CI: 8.7-10.1). Median OS of patients receiving ≥ 1-4 months, >4-6 months and > 6 months of MAC was 8.4 months (95% CI: 7.7-9), 10.2 months (95% CI: 9-11.8), and 12.8 months (95% CI 11.6-16). Twelve-month survival was 37% for patients receiving ≥ 1-4 months, 43% for > 4-6 months, and 56% for > 6 months. Female sex (P = .02), higher median household income (P = .03), and longer duration of MAC (P < .001) were independently associated with improved OS following multivariable analysis.
This analysis in LAPC patients suggests that combination systemic therapy regimens of 6 months or more may optimize survival outcomes. Further investigation on the duration of systemic therapy question in LAPC is needed.
目前缺乏关于晚期胰腺腺癌（LAPC）多药联合系统治疗持续时间的循证推荐。本研究旨在评估联合系统治疗持续时间对 LAPC 患者生存的影响。
本研究使用国家癌症数据库，检索 2004 年至 2014 年间未经治疗的 LAPC 患者。纳入至少接受 1 个月多药化疗（MAC）和 6 个月以上随访的患者。绘制 Kaplan-Meier 生存曲线以评估每个 MAC 持续时间组的 OS。使用单变量和多变量 Cox 比例风险回归分析 OS 与人口统计学和临床变量之间的关系。统计计算使用 SAS 软件版本 9.4 进行。
在 3410 名患者中，有 1114 名符合纳入标准。中位年龄为 64 岁。中位治疗持续时间为 3.2 个月（范围 1-19.8）。中位随访时间为 23.5 个月（范围 3-120）。所有患者的中位 OS 为 9.4 个月（95%CI：8.7-10.1）。接受 MAC 治疗 1-4 个月、4-6 个月和>6 个月的患者中位 OS 分别为 8.4 个月（95%CI：7.7-9）、10.2 个月（95%CI：9-11.8）和 12.8 个月（95%CI：11.6-16）。接受 MAC 治疗 1-4 个月、4-6 个月和>6 个月的患者 12 个月生存率分别为 37%、43%和 56%。多变量分析显示，女性（P=0.02）、较高的中位家庭收入（P=0.03）和较长的 MAC 持续时间（P<0.001）与 OS 改善独立相关。
本研究提示，LAPC 患者的联合系统治疗方案持续 6 个月或更长时间可能优化生存结局。需要进一步研究 LAPC 中系统治疗持续时间的问题。
