Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH.
Case Western Reserve University, Cleveland, OH.
Surgery. 2021 May;169(5):1102-1109. doi: 10.1016/j.surg.2020.11.026. Epub 2020 Dec 26.
Adenosquamous carcinoma of the pancreas has historically poor survival. We analyzed survival outcomes stratified by treatment regimen and sequence using an administrative dataset.
Adult patients with nonmetastatic adenosquamous carcinoma of the pancreas were identified using the National Cancer Database (2010-2016). Multivariable analyses were used to determine factors associated with receipt of neoadjuvant or adjuvant chemotherapy. Overall survival was estimated by Kaplan-Meier analysis and a multivariable Cox model was used to evaluate factors associated with survival.
A total of 838 patients with adenosquamous carcinoma of the pancreas were included in the analysis. The median age was 69 years and 64.7% of patients underwent pancreatectomy. Among patients who underwent pancreatectomy, 60.5% received adjuvant chemotherapy, 14.8% received neoadjuvant chemotherapy, and 24.7% underwent surgery alone. Older age and increasing comorbidity index were associated with a reduced likelihood of receiving neoadjuvant or adjuvant chemotherapy. Median survival of patients who received chemotherapy alone was similar compared with patients who underwent pancreatectomy alone (9.2 vs 7.2 months, P = .504). Survival was improved if patients received both chemotherapy and pancreatectomy (neoadjuvant = 19.6 months, hazard ratio = 0.58; adjuvant = 19.4 months, hazard ratio = 0.64) compared with pancreatectomy alone.
Patients with adenosquamous carcinoma of the pancreas who do not receive multimodal therapy have poor survival. The sequence of chemotherapy and pancreatectomy is not associated with survival, but 25% of patients who undergo surgery do not receive chemotherapy. Given that there is no difference in median survival between patients who undergo pancreatectomy alone or receive chemotherapy alone, our data question whether neoadjuvant chemotherapy should be considered in patients with potentially resectable adenosquamous carcinoma of the pancreas.
胰腺腺鳞癌的生存情况历来较差。我们使用行政数据集按治疗方案和顺序对生存结果进行分层分析。
使用国家癌症数据库（2010-2016 年）确定非转移性胰腺腺鳞癌的成年患者。多变量分析用于确定接受新辅助或辅助化疗的相关因素。通过 Kaplan-Meier 分析估计总生存率，并使用多变量 Cox 模型评估与生存相关的因素。
共纳入 838 例胰腺腺鳞癌患者进行分析。中位年龄为 69 岁，64.7%的患者接受了胰腺切除术。在接受胰腺切除术的患者中，60.5%接受了辅助化疗，14.8%接受了新辅助化疗，24.7%仅接受了手术治疗。年龄较大和合并症指数增加与接受新辅助或辅助化疗的可能性降低相关。单独接受化疗的患者中位生存期与单独接受胰腺切除术的患者相似（9.2 与 7.2 个月，P=0.504）。如果患者接受化疗联合胰腺切除术（新辅助=19.6 个月，风险比=0.58；辅助=19.4 个月，风险比=0.64），则生存情况得到改善，与单独接受胰腺切除术相比。
未接受多模式治疗的胰腺腺鳞癌患者生存情况较差。化疗和胰腺切除术的顺序与生存无关，但 25%接受手术的患者未接受化疗。鉴于单独接受胰腺切除术或单独接受化疗的患者中位生存期无差异，我们的数据质疑对于潜在可切除的胰腺腺鳞癌患者是否应考虑新辅助化疗。
