Youlden Danny R, Chan Bryan A, Clark Jon, Donoghue Victoria K, Allen Michael J
Cancer Alliance Queensland, Metro South Health, Brisbane, Queensland, Australia.
Adem Crosby Cancer Centre, Department of Medical Oncology, Division of Cancer Care Services, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
Cancer Med. 2025 Sep;14(17):e71226. doi: 10.1002/cam4.71226.
The three main chemotherapy regimens for people with unresectable pancreatic cancer include modified FOLFIRINOX (comprising oxaliplatin, irinotecan and fluorouracil, denoted mFFX), gemcitabine with nab-paclitaxel (GnP), and single-agent gemcitabine (GEM). We explored characteristics associated with the type of chemotherapy and variations in survival.
Records for people with unresected pancreatic adenocarcinoma between 2018 and 2022 treated with first-line mFFX, GnP or GEM were extracted from the population-based Queensland Oncology Repository. Multivariable Poisson models were fitted to determine factors associated with each type of chemotherapy, expressed as relative likelihoods (RLs). Variations in three-year observed survival were assessed using flexible parametric modelling and reported in terms of adjusted excess mortality hazard ratios (HRs).
Of the 766 people in the study cohort, 59% were treated with GnP, 27% with mFFX, and 15% with GEM. After adjustment, treatment with mFFX was far more likely in selected private facilities compared to public hospitals (RL = 2.33, 95% CI 1.84-2.96), whereas the GEM regimen was used more often for those from outer regional/remote areas (RL = 2.20 compared to people living in major cities, 95% CI 1.45-3.34; p < 0.001). Three-year survival was very poor at just 5% (95% CI 3%-7%). Nonetheless, adjusted mortality was higher for GnP (HR = 1.30, 95% CI 1.07-1.59) and GEM (HR = 1.53, 95% CI 1.17-2.01) compared to mFFX.
Apart from clinical indications, there should be equity in the treatment received for unresectable pancreatic cancer. Our results suggest, however, that where a person lives and the type of facility at which they are treated may influence their chemotherapy regimen.
对于无法切除的胰腺癌患者，三种主要的化疗方案包括改良的FOLFIRINOX（由奥沙利铂、伊立替康和氟尿嘧啶组成，记为mFFX）、吉西他滨联合纳米白蛋白结合型紫杉醇（GnP）以及单药吉西他滨（GEM）。我们探究了与化疗类型相关的特征以及生存率的差异。
从基于人群的昆士兰肿瘤登记库中提取2018年至2022年间接受一线mFFX、GnP或GEM治疗的无法切除的胰腺腺癌患者的记录。采用多变量泊松模型来确定与每种化疗类型相关的因素，以相对似然比（RLs）表示。使用灵活参数建模评估三年观察生存率的差异，并以调整后的超额死亡风险比（HRs）进行报告。
在研究队列的766名患者中，59%接受了GnP治疗，27%接受了mFFX治疗，15%接受了GEM治疗。调整后，与公立医院相比，在选定的私立机构接受mFFX治疗的可能性要高得多（RL = 2.33，95% CI 1.84 - 2.96），而GEM方案在来自外部地区/偏远地区的患者中使用得更频繁（与居住在大城市的人相比，RL = 2.20，95% CI 1.45 - 3.34；p < 0.001）。三年生存率非常低，仅为5%（95% CI 3% - 7%）。尽管如此，与mFFX相比，GnP（HR = 1.30，95% CI 1.07 - 1.59）和GEM（HR = 1.53，95% CI 1.17 - 2.01）的调整后死亡率更高。
除了临床指征外，无法切除的胰腺癌患者所接受的治疗应具有公平性。然而，我们的结果表明，患者居住的地点以及接受治疗的机构类型可能会影响他们的化疗方案。
