Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Jpn J Clin Oncol. 2021 Apr 30;51(5):728-736. doi: 10.1093/jjco/hyab014.
The prognostic impact of tumour location (pancreatic head vs. pancreatic body/tail) and first-line chemotherapy regimen (gemcitabine plus nab-paclitaxel vs. modified FOLFIRINOX) has not been fully elucidated in locally advanced pancreatic cancer. Therefore, we conducted this study to examine the prognostic impact of tumour location and first-line chemotherapy regimen.
We retrospectively investigated locally advanced pancreatic cancer patients who initiated first-line chemotherapy (gemcitabine plus nab-paclitaxel or modified FOLFIRINOX) between March 2014 and December 2019. We compared clinical characteristics and survival outcomes according to chemotherapy regimen and tumour location. Furthermore, we examined the prognostic factors associated with overall survival using cox proportional hazards model. Distant metastasis pattern was also compared according to tumour location.
A total of 128 patients were included (GnP 95, mFFX 33; Ph 66, Pbt 62). Distribution of chemotherapy regimen was balanced between pancreatic head and pancreatic body/tail cancers. Eight patients underwent conversion surgery and 81 patients (63%) developed distant metastasis. Although patients receiving modified FOLFIRINOX were significantly younger and tended to have better performance status compared to patients receiving gemcitabine plus nab-paclitaxel, radiological tumour response, progression-free survival, overall survival and chemotherapy-related adverse events were similar between the two groups except for grades 3-4 anorexia (9% vs. 1%, P = 0.05). Furthermore, overall survival was similar between pancreatic head and pancreatic body/tail cancers. Conversion surgery and radiation therapy were identified as independent prognostic factors for overall survival. The most common site of distant metastasis was liver metastasis in both groups and pattern of distant metastasis was not different between the two groups.
In our experience, tumour location and first-line chemotherapy regimen were not a prognostic factor for overall survival in locally advanced pancreatic cancer.
肿瘤位置（胰头部与胰体/尾部）和一线化疗方案（吉西他滨联合 nab-紫杉醇与改良 FOLFIRINOX）对局部晚期胰腺癌的预后影响尚未完全阐明。因此，我们开展了这项研究，旨在探讨肿瘤位置和一线化疗方案的预后影响。
我们回顾性调查了 2014 年 3 月至 2019 年 12 月期间接受一线化疗（吉西他滨联合 nab-紫杉醇或改良 FOLFIRINOX）的局部晚期胰腺癌患者。我们根据化疗方案和肿瘤位置比较了临床特征和生存结局。此外，我们使用 Cox 比例风险模型检查了与总生存期相关的预后因素。还根据肿瘤位置比较了远处转移模式。
共纳入 128 例患者（GnP95 例，mFFX33 例；Ph66 例，Pbt62 例）。化疗方案在胰头部和胰体/尾部肿瘤之间分布均衡。8 例患者接受了转化手术，81 例（63%）发生了远处转移。尽管接受改良 FOLFIRINOX 的患者明显比接受吉西他滨联合 nab-紫杉醇的患者更年轻且体力状况更好，但两组之间的影像学肿瘤反应、无进展生存期、总生存期和化疗相关不良事件相似，除了 3-4 级厌食症（9%比 1%，P=0.05）。此外，胰头部和胰体/尾部肿瘤的总生存期相似。转化手术和放疗是总生存期的独立预后因素。两组中最常见的远处转移部位均为肝转移，两组之间的远处转移模式无差异。
根据我们的经验，肿瘤位置和一线化疗方案不是局部晚期胰腺癌总生存期的预后因素。
