From the Divisions of Internal Medicine.
Gastroenterology, Icahn School of Medicine at Mount Sinai.
Pancreas. 2022 Feb 1;51(2):153-158. doi: 10.1097/MPA.0000000000001992.
The aim of this study was to investigate survival in patients who received celiac plexus neurolysis (CPN) compared with patients who received opioids.
The Surveillance, Epidemiology and End Results-Medicare database was used to identify patients older than 65 years diagnosed with pancreatic cancer between 2007 and 2015. We used claims data to identify patients with a history of CPN and opioid use within 1 year of diagnosis, and other demographic, clinical, and treatment variables. Kaplan-Meier analyses and inverse propensity-weighted adjusted Cox proportional hazard ratios were used to evaluate survival.
We identified 648 patients who underwent CPN (19.0%) compared with 2769 patients who received opioids (81.0%). The median survival and interquartile range for patients who received CPN was 4.0 months (2.0-8.0 months) compared with 7.0 months (3.0-12.0 months) for opioid users (P < 0.0001). After adjusting for confounders and propensity score, the patients who received CPN showed worsened survival (hazard ratio, 1.69; 95% confidence interval, 1.59-1.79).
Pancreatic cancer patients who underwent CPN had decreased survival compared with opioid users. This suggests that opioid sparing methods to reduce pancreatic cancer pain may actually be harmful. Future prospective studies should investigate whether other opioid sparing therapies impact pancreatic cancer survival.
本研究旨在比较接受腹腔神经丛松解术（CPN）与接受阿片类药物治疗的患者的生存情况。
使用监测、流行病学和最终结果-医疗保险数据库，确定了 2007 年至 2015 年间被诊断患有胰腺癌且年龄大于 65 岁的患者。我们使用索赔数据来确定在诊断后 1 年内有 CPN 和阿片类药物使用史的患者，以及其他人口统计学、临床和治疗变量。使用 Kaplan-Meier 分析和逆概率加权调整 Cox 比例风险比来评估生存情况。
我们确定了 648 例接受 CPN（19.0%）的患者，与接受阿片类药物（81.0%）的 2769 例患者相比。接受 CPN 的患者的中位生存时间和四分位间距为 4.0 个月（2.0-8.0 个月），而接受阿片类药物的患者为 7.0 个月（3.0-12.0 个月）（P < 0.0001）。在调整混杂因素和倾向评分后，接受 CPN 的患者的生存情况恶化（风险比，1.69；95%置信区间，1.59-1.79）。
与阿片类药物使用者相比，接受 CPN 的胰腺癌患者的生存率降低。这表明，减少胰腺癌疼痛的阿片类药物节约方法实际上可能是有害的。未来的前瞻性研究应调查其他阿片类药物节约疗法是否会影响胰腺癌的生存。
