Nie Duorui, Lan Qingxia, Shi Bin, Xu Fei
College of Pharmacy, Hunan University of Chinese Medicine, Changsha, China.
Graduate School, Hunan University of Chinese Medicine, Changsha, China.
Front Med (Lausanne). 2022 Sep 29;9:958257. doi: 10.3389/fmed.2022.958257. eCollection 2022.
Due to underrepresentation in randomized controlled trials among old people (≥65 years old), the effectiveness of clinical trial-based recommendations about the treatment for stage I pancreatic cancer remains controversial. In this research, we intended to investigate the different strategies of this population in surgery group and non-surgery group.
Elderly patients aged 65 years or older with histologically diagnosed stage I pancreatic cancer from 2006 to 2017 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The included patients were divided into surgery group (receiving surgery with chemotherapy or chemoradiotherapy) and non-surgery group (receiving radiotherapy, chemotherapy, both, or neither). Overall survival (OS) and cancer-specific survival (CSS) were compared between groups by Kaplan-Meier analysis. Cox proportional hazards regression (Cox) proportional hazards regression was used to determine factors associated with survival.
A total of 2,448 eligible patients were recruited. Among them, 18.4% were treated surgically and 81.6% were treated non-surgically. The median OS (mOS) was 26 months (95% CI: 24-30 months) in the surgery group and 7 months (95% CI: 7-8 months) in the non-surgery group. In multivariate analyses, surgery was an important factor in improving OS compared with non-surgical treatment (HR: 0.34, 95% CI: 0.29-0.39, < 0.001). In subgroup analysis, surgery plus chemotherapy was an independent factor for OS in the surgery group, while chemoradiotherapy, chemotherapy, and radiotherapy were independent prognostic factors for patients in the non-surgery group.
Surgical resection and post-operative chemotherapy are recommended for elderly patients with stage I pancreatic cancer who can tolerate treatment, but post-operative chemoradiotherapy does not bring survival benefits compared with post-operative chemotherapy. Moreover, radiotherapy, chemotherapy, or the combination of radiotherapy and chemotherapy are significantly related to the prognosis of elderly patients with untreated pancreatic cancer, but chemoradiotherapy has the most obvious benefit.
由于老年人（≥65岁）在随机对照试验中的代表性不足，基于临床试验的I期胰腺癌治疗建议的有效性仍存在争议。在本研究中，我们旨在调查手术组和非手术组中该人群的不同治疗策略。
从监测、流行病学和最终结果（SEER）数据库中识别出2006年至2017年间组织学诊断为I期胰腺癌的65岁及以上老年患者。纳入的患者分为手术组（接受手术加化疗或放化疗）和非手术组（接受放疗、化疗、两者或均未接受）。通过Kaplan-Meier分析比较两组的总生存期（OS）和癌症特异性生存期（CSS）。采用Cox比例风险回归分析确定与生存相关的因素。
共招募了2448例符合条件的患者。其中，18.4%接受了手术治疗，81.6%接受了非手术治疗。手术组的中位总生存期（mOS）为26个月（95%CI：24 - 30个月），非手术组为7个月（95%CI：7 - 8个月）。在多因素分析中，与非手术治疗相比，手术是改善总生存期的重要因素（HR：0.34，95%CI：0.29 - 0.39，<0.001）。在亚组分析中，手术加化疗是手术组总生存期的独立因素，而放化疗、化疗和放疗是非手术组患者的独立预后因素。
对于能够耐受治疗的老年I期胰腺癌患者，建议进行手术切除和术后化疗，但与术后化疗相比，术后放化疗并不能带来生存获益。此外，放疗、化疗或放化疗联合与未接受治疗的老年胰腺癌患者的预后显著相关，但放化疗的获益最为明显。
