Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, T6G 1Z2, Canada.
Med Oncol. 2021 Feb 3;38(2):18. doi: 10.1007/s12032-021-01469-y.
The aim of the study was to analyze the real-world treatment patterns of adjuvant chemotherapy administration among patients with resected pancreatic adenocarcinoma. Cases with non-metastatic pancreatic adenocarcinoma, diagnosed 2007-2018, treated with upfront surgical resection, and recorded within Alberta Cancer registry were accessed. Multivariable logistic regression analysis was conducted to evaluate factors predicting use of adjuvant chemotherapy. Kaplan-Meier survival estimates and multivariable Cox regression analysis were used to compare overall survival among patients treated with adjuvant gemcitabine versus those treated with adjuvant gemcitabine + capecitabine. A total of 695 patients who have undergone upfront surgical treatment of pancreatic adenocarcinoma, including 445 patients (64%) who received adjuvant chemotherapy and 250 patients (36%) who did not receive adjuvant chemotherapy. The following factors were associated with lower probability to receive adjuvant chemotherapy: older age (OR 0.94; 95% CI 0.93-0.96), node negativity (OR 0.47; 95% CI 0.33-0.67), higher Charlson comorbidity index (OR 0.86; 95% CI 0.74-0.99), and living within the Northern zone of the province (OR for Calgary zone versus North zone: 2.24; 95% CI 1.29-3.90). Within patients who received adjuvant gemcitabine ± capecitabine, factors associated with worse overall survival included higher Charlson comorbidity index (HR 1.18; 95% CI 1.00-1.40), and node-positive disease (HR for node-negative versus node-positive disease: 0.51; 95% CI 0.33-0.78). Type of chemotherapy was not predictive of overall survival (HR for gemcitabine versus gemcitabine plus capecitabine: 1.40; 95% CI 0.98-2.00). P value for interaction between type of chemotherapy and nodal status was 0.038. In this real-world study, the added benefit of adjuvant gemcitabine + capecitabine (compared to adjuvant gemcitabine) seems to be limited to patients with node-positive disease.
本研究旨在分析接受胰腺腺癌切除术患者辅助化疗的实际治疗模式。我们获取了 2007 年至 2018 年间在艾伯塔癌症登记处记录的诊断为非转移性胰腺腺癌、接受初始手术切除并接受治疗的病例。采用多变量逻辑回归分析评估预测辅助化疗使用的因素。使用 Kaplan-Meier 生存估计和多变量 Cox 回归分析比较接受吉西他滨辅助治疗和接受吉西他滨+卡培他滨辅助治疗的患者的总生存率。共有 695 例患者接受了胰腺腺癌的初始手术治疗，其中 445 例（64%）患者接受了辅助化疗，250 例（36%）患者未接受辅助化疗。与接受辅助化疗的可能性较低相关的因素包括年龄较大（OR 0.94；95%CI 0.93-0.96）、淋巴结阴性（OR 0.47；95%CI 0.33-0.67）、Charlson 合并症指数较高（OR 0.86；95%CI 0.74-0.99）和居住在省内北部地区（与卡尔加里地区相比，艾伯塔省北部地区的 OR：2.24；95%CI 1.29-3.90）。在接受吉西他滨±卡培他滨辅助治疗的患者中，与总体生存率较差相关的因素包括较高的 Charlson 合并症指数（HR 1.18；95%CI 1.00-1.40）和淋巴结阳性疾病（与淋巴结阴性疾病相比的 HR：0.51；95%CI 0.33-0.78）。化疗类型不能预测总体生存率（吉西他滨与吉西他滨+卡培他滨的 HR：1.40；95%CI 0.98-2.00）。化疗类型和淋巴结状态之间交互作用的 P 值为 0.038。在这项真实世界研究中，与辅助吉西他滨相比，吉西他滨+卡培他滨（加用）的附加益处似乎仅限于淋巴结阳性疾病患者。
