Tamburrino Domenico, Guarneri Giovanni, Pagnanelli Michele, Crippa Stefano, Partelli Stefano, Belfiori Giulio, Capurso Gabriele, Falconi Massimo
Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Ann Surg Oncol. 2021 Apr;28(4):2312-2322. doi: 10.1245/s10434-020-09097-y. Epub 2020 Sep 12.
Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of cancer-related death in the USA. A wealth of evidence has demonstrated the chemopreventive activity of aspirin, statins, and metformin against PDAC. The aim of this study is to investigate the effect of aspirin, statins, and metformin on disease-free survival (DFS) and disease-specific survival (DSS) in a large population of PDAC patients undergoing pancreatic resection.
All patients who underwent pancreatic resections between January 2015 and September 2018 were retrospectively reviewed. The potentially "chemopreventive agents" considered for the analysis were aspirin, statins, and metformin. Drug use was defined in case of regular assumption at least 6 months before diagnosis and regularly after surgery along the follow-up period.
A total of 430 patients were enrolled in this study, with median DFS and DSS of 21 months (IQR 13-30) months and 34 (IQR 26-52) months, respectively. On multivariable analysis, use of aspirin was associated with better DFS (HR: 0.62; p = 0.038). Metformin was associated with better DFS, without reaching statistical significance (p = 0.083). Use of statins did not influence DFS in the studied population. Aspirin, metformin, and statins were not associated with better DSS on multivariable analysis. Factors influencing DSS were pT3/pT4, N1, N2, no adjuvant treatment, G3, and ASA score > 3.
The results suggest that chronic use of aspirin is associated with increased DFS but not with better DSS after surgical resection in patients with PDAC.
胰腺导管腺癌（PDAC）目前是美国癌症相关死亡的第四大主要原因。大量证据表明阿司匹林、他汀类药物和二甲双胍对PDAC具有化学预防活性。本研究的目的是调查阿司匹林、他汀类药物和二甲双胍对接受胰腺切除术的大量PDAC患者的无病生存期（DFS）和疾病特异性生存期（DSS）的影响。
回顾性分析2015年1月至2018年9月期间接受胰腺切除术的所有患者。分析中考虑的潜在“化学预防剂”为阿司匹林、他汀类药物和二甲双胍。药物使用定义为在诊断前至少6个月定期服用，并在术后随访期间定期服用。
本研究共纳入430例患者，DFS和DSS的中位数分别为21个月（IQR 13 - 30）和34个月（IQR 26 - 52）。多变量分析显示，使用阿司匹林与更好的DFS相关（HR：0.62；p = 0.038）。二甲双胍与更好的DFS相关，但未达到统计学意义（p = 0.083）。在所研究人群中，使用他汀类药物不影响DFS。多变量分析显示，阿司匹林、二甲双胍和他汀类药物与更好的DSS无关。影响DSS的因素为pT3/pT4、N1、N2、无辅助治疗、G3和ASA评分>3。
结果表明，PDAC患者手术切除后长期使用阿司匹林与DFS增加相关，但与更好的DSS无关。
