体尾部局部进展期胰腺癌采用质子放疗提高生存率的治疗策略：一项回顾性研究。

Proton radiotherapy as a treatment strategy to increase survival in locally advanced pancreatic cancer in the body and tail: a retrospective study.

机构信息

Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.

Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan.

出版信息

Radiat Oncol. 2023 Aug 8;18(1):131. doi: 10.1186/s13014-023-02301-9.

DOI:10.1186/s13014-023-02301-9

PMID:37553705

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10408146/

Abstract

BACKGROUND

Long-term outcomes and prognostic factors of proton radiotherapy for locally advanced pancreatic cancer (LAPC) in the body and tail are still unknown. The aim of this study was to determine the prognostic factors after proton radiotherapy in a large group of patients with LAPC in the body and tail.

METHODS

The medical records of 200 patients with LAPC in the body and tail who underwent proton radiotherapy between February 2009 and January 2021 at the Hyogo Ion Beam Medical Center were retrospectively reviewed to identify prognostic factors that contribute to long-term survival.

RESULTS

The overall survival rate at 1- and 2-year after PT was 69.6% and 35.4% with a median overall survival of 18.4 months. The 1- and 2-year local progression-free, and progression-free survival rates were 84.3% and 68.0%, and 44.3% and 19.4%, respectively. In multivariate analysis, superior mesenteric artery (SMA) invasion (SMA only invasion vs. celiac artery only invasion; P = 0.049: SMA and celiac artery invasion vs. celiac artery only invasion; P = 0.017), carbohydrate antigen 19-9 (CA 19-9) level ≥ 231.9 U/mL (P = 0.001), anterior peripancreatic invasion (P = 0.006), and incomplete scheduled concurrent chemotherapy (P = 0.009) were statistically significant prognostic factors for overall survival. There was no significant difference in local progression-free survival; however, distant metastasis-free survival was statistically worse in patients with prognostic factors than in those without.

CONCLUSIONS

Proton radiotherapy for LAPC in the body and tail may be a valuable multidisciplinary treatment option. Patients with SMA invasion, higher pre-proton radiotherapy serum CA 19-9 level, anterior peripancreatic invasion, or incomplete scheduled concurrent chemotherapy had worse overall survival because of worse distant metastasis-free survival, suggesting that distant metastases have a significant impact on overall survival in such patients.

TRIAL REGISTRATION

Retrospectively registered.

摘要

背景

质子放疗治疗体尾部局部晚期胰腺癌（LAPC）的长期疗效和预后因素尚不清楚。本研究旨在确定在大量体尾部 LAPC 患者中，质子放疗后的预后因素。

方法

回顾性分析 2009 年 2 月至 2021 年 1 月在兵库离子束医疗中心接受质子放疗的 200 例体尾部 LAPC 患者的病历，以确定与长期生存相关的预后因素。

结果

PT 后 1 年和 2 年的总生存率分别为 69.6%和 35.4%，中位总生存期为 18.4 个月。1 年和 2 年的局部无进展生存率和无进展生存率分别为 84.3%和 68.0%，44.3%和 19.4%。多因素分析显示，肠系膜上动脉（SMA）侵犯（仅 SMA 侵犯与仅腹腔动脉侵犯比较，P=0.049；SMA 和腹腔动脉侵犯与仅腹腔动脉侵犯比较，P=0.017）、糖类抗原 19-9（CA 19-9）水平≥231.9 U/mL（P=0.001）、前胰周侵犯（P=0.006）和不完全同步放化疗（P=0.009）是总生存的统计学显著预后因素。局部无进展生存率无显著差异；然而，有预后因素的患者无远处转移生存率明显较差。