Role of Neoadjuvant Therapy in the Multimodality Treatment of Older Patients with Pancreatic Cancer
Role of Neoadjuvant Therapy in the Multimodality Treatment of Older Patients with Pancreatic Cancer
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DOI：
10.1016/j.jamcollsurg.2014.02.023
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发表时间：
2014-07-01
影响因子：
5.2
通讯作者：
Katz, Matthew H. G.
中科院分区：
文献类型：
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作者：
Cooper, Amanda B.;Holmes, Holly M.;Katz, Matthew H. G.
背景：对于老年可切除胰腺癌患者，缺乏明确的治疗策略。多篇报道描述了高度精选的成功接受胰腺切除术的老年癌症患者。然而，综合治疗对长期生存至关重要，而且老年患者术后未接受辅助治疗的风险很高。我们试图描述一系列老年胰腺癌患者的治疗模式和结果，这些患者接受了广泛使用新辅助治疗的多模式策略。研究设计：我们回顾了所有70岁及以上患者的治疗计划、短期结果和总存活率，这些患者在9年的时间里接受了潜在的可切除或边缘可切除的胰腺癌的治疗。结果：236名患者中有179人(76%)有治愈意图。在这些患者中，153人(85%)开始接受新辅助治疗：74人(48%)随后接受了胰腺切除术，79人没有因疾病进展(n=46)、功能状态不佳(n=23)或其他原因(n=10)而接受治疗。在26名首次接受手术的患者中，有11人(42%)接受了术后治疗。在有治疗意图的患者中，开始新辅助治疗的所有患者的中位总生存期(16.6个月[2.1月至142.7个月])与接受初次切除的患者(15.1月[5.4月至100.8个月])相似，p=0.53。胰腺切除术后，患者的住院死亡率为2%，91%的患者已出院。结论：在所有70岁及以上的胰腺癌患者中，85%的患者接受了综合治疗。超过90%的人已经出院回家。这些数据表明，新辅助治疗在选择老年患者进行手术方面具有潜在的作用，并支持进一步的研究，以完善针对这一高危人群的个体化治疗方案。(C)美国外科医师学会2014年
BACKGROUND: A well-defined treatment strategy for elderly patients with resectable pancreatic cancer is lacking. Multiple reports have described highly selected older cancer patients who have successfully undergone pancreatectomy. However, multimodality therapy is essential for long-term survival, and elderly patients are at high risk for not receiving adjuvant therapy postoperatively. We sought to describe the treatment patterns and outcomes of a series of elderly patients with pancreatic cancer who were treated with a multimodality strategy that liberally used neoadjuvant therapy.STUDY DESIGN: We retrospectively reviewed treatment plans, short-term outcomes, and overall survival of all patients 70 years old and older, presenting to our institution over a 9-year period, who were treated for potentially resectable or borderline resectable pancreatic cancer.RESULTS: There were 179 (76%) of 236 patients treated with curative intent. Of these patients, 153 (85%) initiated neoadjuvant therapy: 74 (48%) subsequently underwent pancreatectomy and 79 did not due to disease progression (n = 46), insufficient performance status (n = 23), or other reasons (n = 10). Eleven (42%) of 26 patients who underwent surgery first received postoperative therapy. Among patients treated with curative intent, the median overall survival of all patients initiating neoadjuvant therapy (16.6 months [range 2.1 to 142.7 months]) was similar to that of patients undergoing resection primarily (15.1 months [range 5.4 to 100.8 months]), p = 0.53. After pancreatectomy, patients had a 2% in-hospital mortality rate and 91% were discharged home.CONCLUSIONS: Eighty-five percent of all patients 70 years old and older, who underwent pancreatectomy for potentially resectable or borderline resectable pancreatic cancer, received multimodality therapy. More than 90% were discharged home. These data demonstrate a potential role for neoadjuvant therapy in selecting elderly patients for surgery, and support further studies to refine individualized treatment protocols for this high-risk population. (C) 2014 by the American College of Surgeons