FOLFIRINOX 与吉西他滨加 nab-紫杉醇（含序贯治疗）治疗转移性胰腺癌的比较：倾向评分匹配分析。
Comparison between FOLFIRINOX and gemcitabine plus nab-paclitaxel including sequential treatment for metastatic pancreatic cancer: a propensity score matching approach.
机构信息
Center for Liver and Pancreatobiliary Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
BMC Cancer. 2021 May 11;21(1):537. doi: 10.1186/s12885-021-08277-7.
BACKGROUND
FOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GnP) have been recommended as the first-line chemotherapy for metastatic pancreatic cancer (mPC). However, the evidence is lacking comparing not only two regimens, but also sequential treatment (FFX-GnP vs. GnP-FFX).
METHODS
Data of 528 patients (FFX, n = 371; GnP, n = 157) with mPC were collected retrospectively. Propensity score matching was conducted to alleviate imbalance of the two groups. Overall survival (OS), progression free survival (PFS), and toxicity of patients were analyzed.
RESULTS
In the whole population, OS (12.5 months vs. 10.3 months, P = 0.05) and PFS (7.1 months vs. 5.8 months, P = 0.02) were longer in the FFX group before matching and after matching (OS: 11.8 months vs. 10.3 months, P = 0.02; PFS: 7.2 months vs. 5.8 months, P < 0.01). For sequential treatment, OS and PFS showed no significant difference. Interruptions of chemotherapy due to toxicities were more frequent (6.8 vs. 29.3%, P < 0.001) in the GnP group, and cessation of chemotherapy showed a significant association with mortality (z = - 1.94, P = 0.03).
CONCLUSIONS
FFX achieved a longer overall survival than GnP in mPC, but not in the comparison for sequential treatment. More frequent adverse events followed by treatment interruptions during GnP might lead to a poor survival outcome. Therefore, FFX would be a better first-line treatment option than GnP for mPC.
背景
FOLFIRINOX（FFX）和吉西他滨加 nab-紫杉醇（GnP）已被推荐为转移性胰腺癌（mPC）的一线化疗药物。然而，不仅两种方案之间缺乏证据，而且序贯治疗（FFX-GnP 与 GnP-FFX）之间也缺乏证据。
方法
回顾性收集了 528 例 mPC 患者（FFX，n=371；GnP，n=157）的数据。采用倾向评分匹配法缓解两组间的不平衡。分析患者的总生存期（OS）、无进展生存期（PFS）和毒性。
结果
在全人群中，FFX 组的 OS（12.5 个月 vs. 10.3 个月，P=0.05）和 PFS（7.1 个月 vs. 5.8 个月，P=0.02）在匹配前和匹配后均较长。对于序贯治疗，OS 和 PFS 无显著差异。由于毒性而中断化疗的频率更高（6.8%比 29.3%，P<0.001），且化疗停止与死亡率显著相关（z=-1.94，P=0.03）。
结论
FFX 治疗 mPC 的总体生存期长于 GnP，但序贯治疗的比较结果并非如此。在 GnP 治疗期间，由于毒性而中断治疗的频率更高，可能导致不良生存结果。因此，FFX 可能是 mPC 的一线治疗选择优于 GnP。
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