Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan.
Medicine (Baltimore). 2021 Oct 29;100(43):e27591. doi: 10.1097/MD.0000000000027591.
Most patients with pancreatic cancer are ineligible for curative resection at diagnosis, resulting in poor prognosis. This study aimed to evaluate the prognostic factors in patients with unresectable pancreatic cancer.We retrospectively collected clinical data from 196 patients with unresectable pancreatic cancer who received palliative chemotherapy (N = 153) or palliative care alone (N = 43) from January 2011 to December 2013. Patients' background data and overall survival were analyzed using the Cox proportional hazard regression model.In patients receiving palliative chemotherapy (gemcitabine-based regimen, 88.2%) and palliative care alone, the median (range) ages were 68 (43-91) and 78 (53-90) years, and metastatic diseases were present in 80% (N = 123) and 86% (N = 37), respectively. Multivariate analysis in the palliative chemotherapy patients showed that liver metastasis (hazard ratio [HR] 2.25, 95% confidence interval [CI] 1.58-3.20, P < .001), neutrophil-to-lymphocyte ratio (>4.5 vs ≤4.5; HR 3.45, 95% CI 2.22-5.36, P < .001), and cancer antigen 19-9 (CA19-9) (≥900 vs <900 U/mL; HR 1.45, 95% CI 1.02-2.05, P = .036) were independent prognostic factors. In those receiving palliative care alone, lung (HR 3.27, 95% Cl 1.46-7.35, p = 0.004) and peritoneum (HR 2.50, 95% CI 1.20-5.18, P = .014) metastases and the C-reactive protein-to-albumin ratio (≥1.3 vs <1.3; HR 3.33, 95% Cl 1.51-7.35, P = .003) were independent prognostic factors. Furthermore, patients with multiple factors had worse prognosis in both groups. Median survival time of palliative chemotherapy patients with risk factors 0, 1, 2, and 3 were 13.1 (95% CI 8.0-16.9), 9.4 (95% CI 7.9-10.1), 6.6 (95% CI 4.9-7.8), and 2.5 (95% CI 1.7-4.0) months, respectively. Similarly, median survival time was 5.7 (95% CI 1.3 -8.0), 2.1 (95% CI 1.5-3.9), and 1.3 (95% CI 0.6-1.7) months, respectively, for palliative care alone patients with risk factor 0, 1, and 2 to 3.Prognostic markers for pancreatic cancer were neutrophil-to-lymphocyte ratio, liver metastasis, and CA19-9 in patients undergoing palliative chemotherapy and C-reactive protein-to-albumin ratio and lung/peritoneum metastases in patients undergoing palliative care alone. These simple markers should be considered when explaining the prognosis and therapeutic options to patients.
大多数胰腺癌患者在诊断时不适合进行根治性切除术，导致预后不良。本研究旨在评估不可切除胰腺癌患者的预后因素。
我们回顾性收集了 2011 年 1 月至 2013 年 12 月期间接受姑息化疗（N=153）或单纯姑息治疗（N=43）的 196 例不可切除胰腺癌患者的临床数据。使用 Cox 比例风险回归模型分析患者的背景数据和总生存期。
在接受姑息化疗（吉西他滨为基础的方案，88.2%）和单纯姑息治疗的患者中，中位（范围）年龄分别为 68（43-91）和 78（53-90）岁，分别有 80%（N=123）和 86%（N=37）存在转移性疾病。多变量分析显示，肝转移（风险比[HR]2.25，95%置信区间[CI]1.58-3.20，P<.001）、中性粒细胞与淋巴细胞比值（>4.5 与≤4.5；HR 3.45，95%CI 2.22-5.36，P<.001）和癌抗原 19-9（CA19-9）（≥900 与<900 U/mL；HR 1.45，95%CI 1.02-2.05，P=.036）是接受姑息化疗患者的独立预后因素。在接受单纯姑息治疗的患者中，肺（HR 3.27，95%Cl 1.46-7.35，p=.004）和腹膜（HR 2.50，95%CI 1.20-5.18，p=.014）转移和 C 反应蛋白与白蛋白比值（≥1.3 与<1.3；HR 3.33，95%Cl 1.51-7.35，p=.003）是独立的预后因素。此外，两组中具有多种因素的患者预后更差。姑息化疗患者具有 0、1、2 和 3 个危险因素的中位生存时间分别为 13.1（95%CI 8.0-16.9）、9.4（95%CI 7.9-10.1）、6.6（95%CI 4.9-7.8）和 2.5（95%CI 1.7-4.0）个月。同样，接受单纯姑息治疗的患者具有 0、1 和 2 至 3 个危险因素的中位生存时间分别为 5.7（95%CI 1.3-8.0）、2.1（95%CI 1.5-3.9）和 1.3（95%CI 0.6-1.7）个月。
对于接受姑息化疗的患者，预后因素为中性粒细胞与淋巴细胞比值、肝转移和 CA19-9，对于接受单纯姑息治疗的患者，预后因素为 C 反应蛋白与白蛋白比值和肺/腹膜转移。在向患者解释预后和治疗选择时，应考虑这些简单的标志物。
