Prognostic Factors for Survival and Resection in Patients With Initial Nonresectable Locally Advanced Pancreatic Cancer Treated With Chemoradiotherapy
Prognostic Factors for Survival and Resection in Patients With Initial Nonresectable Locally Advanced Pancreatic Cancer Treated With Chemoradiotherapy
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DOI：
10.1016/j.ijrobp.2011.09.008
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发表时间：
2012-07-01
影响因子：
7
通讯作者：
Pfeiffer, Per
中科院分区：
文献类型：
--
作者：
Bjerregaard, Jon K.;Mortensen, Michael B.;Pfeiffer, Per
背景和目的：对于局部晚期胰腺癌（LAPC）患者的最佳治疗方案存在争议。尽管总体预后仍然不佳，但已知某些亚组可受益于强化治疗，包括放化疗 (CRT)。我们描述了 2001 年至 2010 年期间治疗的 178 名患者的结果，并针对这些患者的生存和随后切除的可能性开发了一个预后模型。 方法和材料：从 2001 年到 2010 年，连续治疗了 178 名 LAPC 患者，并纳入本研究，CRT 包括 27 次 50 Gy 联合替加氟尿嘧啶 (UFT)/亚叶酸 结果：诊断后中位生存期为 11.5 个月。 36%的患者出现3级或以上的不良事件。百分之九十三的患者完成了所有分数。生存的 Cox 回归模型表明，切除（风险比 [HR] 0.12；95% 置信区间 [CI]，0.1-0.3）和 CRT 前基于吉西他滨的治疗（HR 0.57；95% CI，0.4-0.9）与良好的结果相关，增加肿瘤总体积（HR 1.14；95% CI，1.0-1.3）与良好的结果相关。 生存期较短。逻辑回归模型显示，III 期疾病（优势比 [OR] 0.16；95% CI，0.0-1.1）和血红蛋白异常（OR 0.26；95% CI，0.0-1.2）与较低的切除几率相关。结论：这项研究证实了 CRT 前接受吉西他滨治疗的患者预后良好，而肿瘤体积增加则预后不良。此外，血红蛋白异常和 III 期疾病患者的 CRT 很少引起肿瘤缩小，从而允许随后进行切除。 (C) 2012 爱思唯尔公司。
Background and Purpose: Controversies regarding the optimal therapy for patients with locally advanced pancreatic cancer (LAPC) exist. Although the prognosis as a whole remains dismal, subgroups are known to benefit from intensive therapy, including chemoradiotherapy (CRT). We describe the results in 178 patients treated from 2001 to 2010 and have developed a prognostic model for both survival and the possibility of a subsequent resection in these patients.Methods and Materials: From 2001 until 2010, 178 consecutive patients with LAPC were treated and included in the present study, with CRT consisting of 50 Gy in 27 fractions combined with tegafur-uracil(UFT)/folinic acid(FA).Results: The median survival from diagnosis was 11.5 months. Adverse events of Grade 3 or above were seen in 36% of the patients. Ninety-three percent of the patients completed all fractions. A Cox regression model for survival demonstrated resection (hazard ratio [HR] 0.12; 95% confidence interval [CI], 0.1-0.3) and pre-CRT gemcitabine-based therapy (HR 0.57; 95% CI, 0.4-0.9) as being associated with a favorable outcome, increasing gross tumor volume (HR 1.14; 95% CI, 1.0-1.3) was associated with shorter survival. A logistic regression model showed Stage III disease (odds ratio [OR] 0.16; 95% CI, 0.0-1.1) and abnormal hemoglobin (OR 0.26; 95% CI, 0.0-1.2) as being associated with lower odds of resection.Conclusion: This study confirms the favorable prognosis for patients receiving gemcitabine therapy before CRT and the poor prognosis associated with increasing tumor volume. In addition, CRT in patients with abnormal hemoglobin and Stage III disease rarely induced tumor shrinkage allowing subsequent resection. (C) 2012 Elsevier Inc.