Impact of Concurrent Medication Use on Pancreatic Cancer Survival-SEER-Medicare Analysis.
Impact of Concurrent Medication Use on Pancreatic Cancer Survival-SEER-Medicare Analysis.
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DOI：
10.1097/coc.0000000000000359
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发表时间：
2018-08
期刊：
影响因子：
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通讯作者：
Mortensen EM
中科院分区：
文献类型：
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作者：
Beg MS;Gupta A;Sher D;Ali S;Khan S;Gao A;Stewart T;Ahn C;Berry J;Mortensen EM
临床前研究表明，非胰腺癌药物的使用可能会影响胰腺癌生物学。我们在一个大型医疗索赔数据库中研究了几种药物类别对胰腺癌生存率的影响。从监测、流行病学和最终结果（SEER）-医疗保险数据库中分析了2006年至2009年间诊断的组织学确诊的胰腺癌，并提供了D部分数据。药物使用被定义为在胰腺癌诊断后12个月内填写两个处方。分析了以下药物类别/组合：β受体阻滞剂、他汀类药物、胰岛素、二甲双胍、噻唑烷二酮（TZD）、华法林、肝素、β受体阻滞剂/他汀类药物、二甲双胍/他汀类药物和β受体阻滞剂/二甲双胍。构建多变量考克斯比例风险模型，调整年龄、性别、种族、诊断分期、癌症部位和Charlson合并症指数，以检验药物类别与总生存期之间的相关性。13，702例患者入组研究;中位年龄76岁，42.5%为男性，77.1%为白色。诊断时最常见的解剖部位和分期分别为胰头（49.9%）和4期（49.6%）。94%的患者在随访期间死亡（中位总生存期5.3个月）。多变量考克斯回归分析显示，β受体阻滞剂、肝素、胰岛素和华法林的使用与生存率的改善显著相关（每一种p<0.05），而二甲双胍、TZD、他汀类药物和联合治疗与此无关。在这项研究中，β受体阻滞剂、肝素、胰岛素和华法林的使用与胰腺癌患者生存率的提高相关。需要更多的研究来验证这些发现在临床环境中。
Preclinical studies have suggested that non-antineoplastic medication use may impact pancreatic cancer biology. We examined the association of several medication classes on pancreatic cancer survival in a large medical claims database. Histologically confirmed pancreatic adenocarcinoma diagnosed between 2006 and 2009 were analyzed from the Surveillance, Epidemiology and End Results (SEER)-Medicare database with available Part D data. Drug use was defined as having two prescriptions filled within 12 months of pancreatic cancer diagnosis. The following medication classes/combinations were analyzed: beta-blocker, statin, insulin, metformin, thiazolidinedione (TZD), warfarin, heparin, beta-blocker/statin, metformin/statin and beta-blocker/metformin. Multivariable Cox proportional hazard models adjusting for age, gender, race, stage at diagnosis, site of cancer, and Charlson comorbidity index were constructed to test the association between medication classes and overall survival. 13,702 patients were included in the study; median age 76 years, 42.5% males, 77.1% white. The most common anatomical site and stage at diagnosis were head of the pancreas (49.9%) and stage 4 (49.6%) respectively. 94% of patients died in the follow-up period (median overall survival 5.3 months). Multivariable Cox regression analysis showed that use of beta blockers, heparin, insulin and warfarin were significantly associated with improved survival (p<0.05 for each one), whereas metformin, TZD, statin and combination therapies were not. In this study, use of beta blockers, heparin, insulin and warfarin were associated with improved survival in patients with pancreatic cancer. Additional studies are needed to validate these findings in the clinical setting.