Takeda Tsuyoshi, Sasaki Takashi, Mie Takafumi, Furukawa Takaaki, Yamada Yuto, Kasuga Akiyoshi, Matsuyama Masato, Ozaka Masato, Sasahira Naoki
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Pancreatology. 2021 Aug;21(5):903-911. doi: 10.1016/j.pan.2021.03.006. Epub 2021 Mar 18.
Peritoneal metastasis is one of the most important poor prognostic factors in advanced pancreatic cancer (PC). Whether the prognosis of PC with peritoneal metastasis has improved with the advent of gemcitabine plus nab-paclitaxel (GnP) and modified FOLFIRINOX (mFFX) is uncertain. The aim of this study was to evaluate the improvements in treatment outcomes of PC with peritoneal metastasis.
We retrospectively investigated consecutive PC patients with peritoneal metastasis treated with chemotherapy at our institution between 2010 and 2019. We compared the clinical characteristics and survival outcomes according to the period of diagnosis (group A, 2010-2014; group B, 2015-2019) and chemotherapy regimen. We also examined the prognostic factors for overall survival (OS).
Among 180 patients included (GnP 88; mFFX 14; other regimens 78), distant metastasis was confined to the peritoneum in 89 patients. Although group B had a worse performance status compared to group A, median OS was significantly longer in group B. GnP and mFFX showed a significantly higher objective response rate and disease control rate in addition to longer progression free survival and OS compared to other regimens. The administration of GnP or mFFX, performance status, and neutrophil to lymphocyte ratio ≥5 were identified as independent prognostic factors for OS. Furthermore, the amount of ascites and extent of peritoneal metastasis were significantly associated with OS in patients with distant metastasis confined to the peritoneum.
The prognosis of PC with peritoneal metastasis has significantly improved over time with the advent of GnP and mFFX.
腹膜转移是晚期胰腺癌（PC）最重要的不良预后因素之一。随着吉西他滨联合白蛋白结合型紫杉醇（GnP）和改良的FOLFIRINOX（mFFX）方案的出现，伴有腹膜转移的PC患者的预后是否有所改善尚不确定。本研究的目的是评估伴有腹膜转移的PC患者治疗结局的改善情况。
我们回顾性研究了2010年至2019年期间在我院接受化疗的连续性伴有腹膜转移的PC患者。我们根据诊断时间（A组，2010 - 2014年；B组，2015 - 2019年）和化疗方案比较了临床特征和生存结局。我们还研究了总生存（OS）的预后因素。
纳入的180例患者中（GnP方案88例；mFFX方案14例；其他方案78例），89例患者远处转移局限于腹膜。尽管B组的体能状态较A组差，但B组的中位OS显著更长。与其他方案相比，GnP和mFFX除了无进展生存期和OS更长外，客观缓解率和疾病控制率也显著更高。GnP或mFFX的使用、体能状态以及中性粒细胞与淋巴细胞比值≥5被确定为OS的独立预后因素。此外，对于远处转移局限于腹膜的患者，腹水量和腹膜转移范围与OS显著相关。
随着GnP和mFFX方案的出现，伴有腹膜转移的PC患者的预后随时间推移有显著改善。
