Department of Clinical Sciences, Oncology and Pathology, Faculty of Medicine, Lund University, Lund, Sweden.
Department of Oncology, Blekinge Hospital, Karlskrona, Sweden.
Acta Oncol. 2021 Dec;60(12):1580-1588. doi: 10.1080/0284186X.2021.1973680. Epub 2021 Sep 6.
Pancreatic cancer is a highly lethal disease with a close association between incidence and mortality. First-line (FL) palliative chemotherapy prolongs survival and alleviates cancer-related symptoms. However, the survival benefit of second-line (SL) treatment is uncertain, as studies fail to consistently show prolonged survival for any given SL treatment, and in the absence of prognostic factors patients will receive a futile treatment. The aim of this study was to examine prognostic factors and survival in patients with pancreatic cancer, with special reference to SL therapy.
This retrospective study included all patients with histopathologically verified pancreatic adenocarcinoma who received palliative chemotherapy at Skåne University Hospital and died between 1 Feb 2015 and 31 Dec 2017.
During the study period, a total of 170 patients with pancreatic cancer died after receiving palliative chemotherapy. Of these, 72 had received SL treatment after progression on FL treatment. Median overall survival (OS) from the start of SL treatment was 5.0 months (95% CI: 4.0-6.1). Median OS was 2.9 months for patients with performance status 2 at start of SL treatment compared to 5.3 months for patients with performance status 0-1 ( = .03), and 3.5 months (95% CI: 3.0-5.4) in patients with hypoalbuminemia (<36 g/L) at the start of SL therapy compared to 8.0 months (95% CI: 5.3-11.1) for patients with normal albumin levels ( = .009). Weight loss during FL therapy, a doubling of CA 19-9 after FL therapy, and length of progression-free survival during FL treatment were not associated with survival following SL therapy.
Poor performance status and hypoalbuminemia are negative prognostic factors for survival on SL palliative treatment in patients with advanced pancreatic cancer. Possible gain in survival should be carefully considered before initiating SL chemotherapy.
胰腺癌是一种高致死性疾病，其发病率和死亡率密切相关。一线（FL）姑息化疗可延长生存期并缓解癌症相关症状。然而，二线（SL）治疗的生存获益并不确定，因为研究未能始终表明任何特定的 SL 治疗都能延长生存期，而且在没有预后因素的情况下，患者将接受无效治疗。本研究旨在探讨胰腺癌患者的预后因素和生存情况，特别关注 SL 治疗。
这是一项回顾性研究，纳入了所有在斯堪尼亚大学医院接受姑息化疗并于 2015 年 2 月 1 日至 2017 年 12 月 31 日期间死亡的组织病理学证实为胰腺腺癌的患者。
在研究期间，共有 170 名接受姑息化疗的胰腺癌患者死亡。其中，72 名患者在 FL 治疗进展后接受了 SL 治疗。从 SL 治疗开始的中位总生存期（OS）为 5.0 个月（95%CI：4.0-6.1）。SL 治疗开始时体能状态为 2 的患者中位 OS 为 2.9 个月，而体能状态为 0-1 的患者中位 OS 为 5.3 个月（ = .03），SL 治疗开始时低白蛋白血症（<36g/L）的患者中位 OS 为 3.5 个月（95%CI：3.0-5.4），而白蛋白水平正常的患者中位 OS 为 8.0 个月（95%CI：5.3-11.1）（ = .009）。FL 治疗期间的体重减轻、FL 治疗后 CA 19-9 加倍以及 FL 治疗期间无进展生存期的长短与 SL 治疗后的生存无关。
在晚期胰腺癌患者中，SL 姑息治疗的生存不良预后因素为体能状态差和低白蛋白血症。在开始 SL 化疗之前，应仔细考虑可能的生存获益。
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