Jang Dong Kee, Kim Young Ae, Lee Jang Won, Kim Hak-June, Lee Yoon Suk, Chun Jung Won, Lee Jong-Chan, Woo Sang Myung, Hwang Jin-Hyeok
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea.
Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea.
J Clin Med. 2024 May 30;13(11):3229. doi: 10.3390/jcm13113229.
: The survival rate of patients with pancreatic cancer (PC) has improved gradually since the introduction of FOLFIRINOX (FFX) and gemcitabine + albumin-bound paclitaxel (GnP) regimens. However, the trends and outcomes of initial palliative chemotherapy before and after the advent of these regimens and their contribution to survival rates are not well understood. This study aimed to investigate this in patients with PC in Korea using claims data from the National Health Insurance Service (NHIS). Patients diagnosed with PC who underwent initial palliative chemotherapy between 2007 and 2019 were identified from the NHIS database. Patient demographics, comorbidities, chemotherapy regimens, and survival rates were analyzed using follow-up data up to 2020. In total, 14,760 patients (mean age, 63.78 ± 10.18 years; men, 59.19%) were enrolled. As initial palliative chemotherapy, 3823 patients (25.90%) received gemcitabine alone; 2779 (18.83%) received gemcitabine + erlotinib; 1948 (13.20%) received FFX; and 1767 (11.97%) received GnP. The median survival values were 15.00 months for FFX; 11.04 months for GnP; 8.40 months for gemcitabine alone; and 8.51 months for gemcitabine + erlotinib. The adjusted hazard ratio (aHR) for GnP vs. FFX was 1.291 (95% CI, 1.206-1.383) in the multivariate Cox regression analysis of mortality. Radiation therapy (aHR, 0.667; 95% CI, 0.612-0.728) and second-line chemotherapy (aHR, 0.639; 95% CI, 0.597-0.684) were significantly associated with improved survival. : Our study found that first-line chemotherapy with FFX was associated with significantly longer survival than the other regimens, although caution is needed in interpreting the results.
自引入FOLFIRINOX（FFX）和吉西他滨+白蛋白结合型紫杉醇（GnP）方案以来，胰腺癌（PC）患者的生存率逐渐提高。然而，在这些方案出现之前和之后初始姑息化疗的趋势和结果及其对生存率的贡献尚不清楚。本研究旨在利用韩国国民健康保险服务（NHIS）的理赔数据对韩国PC患者进行调查。从NHIS数据库中识别出2007年至2019年间接受初始姑息化疗的PC患者。使用截至2020年的随访数据分析患者的人口统计学特征、合并症、化疗方案和生存率。总共纳入了14760例患者（平均年龄63.78±10.18岁；男性占59.19%）。作为初始姑息化疗，3823例患者（25.90%）仅接受吉西他滨治疗；2779例（18.83%）接受吉西他滨+厄洛替尼治疗；1948例（13.20%）接受FFX治疗；1767例（11.97%）接受GnP治疗。FFX的中位生存值为15.00个月；GnP为11.04个月；仅吉西他滨为8.40个月；吉西他滨+厄洛替尼为8.51个月。在死亡率的多因素Cox回归分析中，GnP与FFX相比的调整后风险比（aHR）为1.291（95%CI，1.206 - 1.383）。放射治疗（aHR，0.667；95%CI，0.612 - 0.728）和二线化疗（aHR，0.639；95%CI，0.597 - 0.684）与生存率提高显著相关。我们的研究发现，尽管在解释结果时需要谨慎，但与其他方案相比，FFX一线化疗与显著更长的生存期相关。
