胰腺腺癌生存模式的演变：一项23年的回顾性观察分析。
Evolving survival patterns in pancreatic adenocarcinoma: a 23-year retrospective observational analysis.
作者信息
Felismino Tiago Cordeiro, Rodrigues Diego, Brito Angelo, Silva Virgilio, Durant Lais, Ribeiro Heber, Diniz Alessandro, Farias Igor, Godoy André, Torres Silvio, Curado Maria Paula, Coimbra Felipe
机构信息
Department of Clinical Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil.
Hospital-Based Cancer Registry, A.C. Camargo Cancer Center, São Paulo, Brazil.
出版信息
J Gastrointest Oncol. 2025 Jun 30;16(3):1280-1286. doi: 10.21037/jgo-2024-942. Epub 2025 Jun 26.
BACKGROUND
Pancreatic adenocarcinoma (PA) remains one of the most lethal malignancies. However, treatment options have expanded. Since 2011, FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) and nab-paclitaxel plus gemcitabine have demonstrated superior outcomes over gemcitabine for advanced disease and have become standard chemotherapy regimens. This study aimed to analyze 23-year survival trends in PA at a Brazilian cancer center, focusing on comparisons between the pre- and post-FOLFIRINOX eras.
METHODS
This retrospective study analyzed patients diagnosed and treated at a large cancer center from 2000 to 2023, examining survival trends and changes in clinicopathological features and treatment across two 12-year periods: Period 1 (2000-2011), before FOLFIRINOX, and Period 2 (2012-2023), after FOLFIRINOX incorporation. The primary objective was to compare overall survival rates between the two time periods. The secondary objective was to evaluate changes in clinicopathological characteristics and treatment modalities.
RESULTS
A total of 1,078 patients were included in this analysis, with 274 patients in Period 1 and 804 patients in Period 2. The proportion of female patients increased in Period 2 (43.8% in Period 1 50.9% in Period 2, P=0.051), and the median age at diagnosis rose from 62.5 to 66 years (P<0.001). Early-stage tumors (stages I-II) were more frequently diagnosed in Period 2 (16% 29.8%, P<0.001). Chemotherapy use increased from 70.1% (192 patients) in Period 1 to 83.2% (669 patients) in Period 2 (P<0.001), while multimodal therapy (surgery + chemotherapy) rose from 11.3% to 16.7% (P<0.001). Median overall survival (mOS) improved from 7.29 months in Period 1 to 13.24 months in Period 2 (P<0.001), with the 5-year survival increasing from 5.2% to 14.3%. Among the early-stage patients, mOS increased from 19.7 to 34.4 months (P=0.01). No survival difference was observed for stage III disease (mOS: 16.7 14.8 months, P=0.76), while outcomes for stage IV improved (mOS: 4.76 9.99 months, P<0.001).
CONCLUSIONS
This 23-year analysis highlights the evolving treatment landscape and improved outcomes in PA with the introduction of more effective therapies.
背景
胰腺腺癌（PA）仍然是最致命的恶性肿瘤之一。然而，治疗选择已经有所增加。自2011年以来，FOLFIRINOX方案（氟尿嘧啶、亚叶酸钙、奥沙利铂和伊立替康）以及白蛋白结合型紫杉醇联合吉西他滨已显示出在晚期疾病治疗中优于吉西他滨的效果，并已成为标准化疗方案。本研究旨在分析巴西一家癌症中心PA患者23年的生存趋势，重点比较FOLFIRINOX时代前后的情况。
方法
这项回顾性研究分析了2000年至2023年在一家大型癌症中心诊断和治疗的患者，考察了两个12年期间的生存趋势以及临床病理特征和治疗的变化：第1阶段（2000 - 2011年），FOLFIRINOX方案应用之前；第2阶段（2012 - 2023年），FOLFIRINOX方案应用之后。主要目的是比较两个时间段的总生存率。次要目的是评估临床病理特征和治疗方式的变化。
结果
本分析共纳入了1078例患者，其中第1阶段274例，第2阶段804例。第2阶段女性患者比例增加（第1阶段为43.8%，第2阶段为50.9%，P = 0.051），诊断时的中位年龄从62.5岁升至66岁（P < 0.001）。第2阶段更频繁地诊断出早期肿瘤（I - II期，16%对29.8%，P < 0.001）。化疗的使用从第1阶段的70.1%（192例患者）增加到第2阶段的83.2%（669例患者）（P < 0.001），而多模式治疗（手术 + 化疗）从11.3%升至16.7%（P < 0.001）。中位总生存期（mOS）从第1阶段的7.29个月改善至第2阶段的13.24个月（P < 0.001），5年生存率从5.2%提高到14.3%。在早期患者中，mOS从19.7个月增加到34.4个月（P = 0.01）。III期疾病未观察到生存差异（mOS：16.7对14.8个月，P = 0.76），而IV期的结果有所改善（mOS：4.76对9.99个月，P < 0.001）。
结论
这项23年的分析突出了随着更有效治疗方法的引入，PA治疗格局的演变以及预后的改善。
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