晚期胰腺癌患者的胰腺外分泌功能不全和胰腺酶替代治疗：系统评价和荟萃分析。
Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis.
机构信息
Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
出版信息
United European Gastroenterol J. 2020 Nov;8(9):1115-1125. doi: 10.1177/2050640620938987. Epub 2020 Jul 6.
BACKGROUND
Pancreatic cancer is the fourth leading cause of cancer mortality. Most patients are diagnosed with advanced pancreatic cancer, either at locally advanced or metastatic stages, and have a high rate of malnutrition and weight loss which are associated with poor outcomes. Pancreatic exocrine insufficiency is one of the causes of malnutrition and weight loss in these patients. The prevalence and clinical consequences of pancreatic exocrine insufficiency in advanced pancreatic cancer are poorly investigated with heterogeneous results. We sought to determine the prevalence and clinical consequences of pancreatic exocrine insufficiency and the effect of pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer by systematic review and meta-analysis.
METHODS
Scopus, Medline, and Embase were searched for cohort studies or randomised clinical trials reporting pancreatic exocrine insufficiency and/or the effect of pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer. We considered pancreatic exocrine insufficiency as an abnormal result on direct and/or indirect pancreatic exocrine function tests. Pancreatic enzyme replacement therapy was evaluated by its effect on survival and quality of life in patients with advanced pancreatic cancer.
RESULTS
A total of 11 studies were included; seven studies reported the prevalence of pancreatic exocrine insufficiency and seven the effect of pancreatic enzyme replacement therapy in advanced pancreatic cancer. The pooled prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer was 72% (95% confidence interval: 55-86%), being significantly higher when tumours were located in the pancreatic head (relative risk = 3.36, 1.07-10.54; = 0.04) six studies investigated the impact of pancreatic enzyme replacement therapy on survival/quality of life. Pancreatic enzyme replacement therapy was associated with 3.8 months (95% confidence interval: 1.37-6.19) survival benefit. Patients receiving pancreatic enzyme replacement therapy had a trend towards a better quality of life. The prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer is substantial and its treatment can improve the outcomes of these patients.
背景
胰腺癌是癌症死亡的第四大主要原因。大多数患者被诊断为局部晚期或转移性晚期胰腺癌，营养不良和体重减轻的发生率很高，这与不良预后相关。胰腺外分泌不足是这些患者营养不良和体重减轻的原因之一。在晚期胰腺癌中，胰腺外分泌不足的患病率和临床后果尚未得到充分研究，结果存在差异。我们旨在通过系统评价和荟萃分析来确定晚期胰腺癌患者胰腺外分泌不足的患病率及其对临床后果的影响，以及胰腺酶替代治疗的效果。
方法
在 Scopus、Medline 和 Embase 中搜索了报道晚期胰腺癌患者胰腺外分泌不足和/或胰腺酶替代治疗效果的队列研究或随机临床试验。我们将直接和/或间接胰腺外分泌功能试验异常结果定义为胰腺外分泌不足。通过评估胰腺酶替代治疗对晚期胰腺癌患者生存和生活质量的影响来评价胰腺酶替代治疗。
结果
共纳入 11 项研究；其中 7 项研究报道了晚期胰腺癌中胰腺外分泌不足的患病率，7 项研究报道了胰腺酶替代治疗对晚期胰腺癌的疗效。晚期胰腺癌中胰腺外分泌不足的总患病率为 72%（95%置信区间：55-86%），当肿瘤位于胰头时明显更高（相对风险=3.36，1.07-10.54；=0.04）。有 6 项研究调查了胰腺酶替代治疗对生存/生活质量的影响。胰腺酶替代治疗可使患者的生存获益 3.8 个月（95%置信区间：1.37-6.19）。接受胰腺酶替代治疗的患者生活质量有改善趋势。晚期胰腺癌中胰腺外分泌不足的患病率较高，其治疗可改善这些患者的预后。
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