Efficacy of chemotherapy in elderly patients with unresectable pancreatic cancer: a multicenter review of 895 patients.
Efficacy of chemotherapy in elderly patients with unresectable pancreatic cancer: a multicenter review of 895 patients.
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DOI：
10.1186/s12876-017-0623-8
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发表时间：
2017-05-22
影响因子：
2.4
通讯作者：
Ehime Pancreato-Cholangiology (EPOCH) Study Group
中科院分区：
文献类型：
--
作者：
Kuroda T;Kumagi T;Yokota T;Azemoto N;Hasebe A;Seike H;Nishiyama M;Inada N;Shibata N;Miyata H;Kawamura T;Imai Y;Ueno-Toshimori A;Tanaka Y;Terao T;Imamura Y;Koizumi M;Yamanishi H;Ohno Y;Hiasa Y;Ehime Pancreato-Cholangiology (EPOCH) Study Group
化疗对不能切除的胰腺癌的疗效有所提高。然而，有时很难为老年患者做出治疗决定。我们回顾了一个大型队列研究中不能切除的老年胰腺癌患者的结局，并评估了他们是否接受了化疗及其原因。对895例接受化疗或最佳支持治疗的胰腺癌患者的数据进行分析，考虑人口统计学、临床分期、治疗和结局。适当时，使用卡方检验、Student t检验或Mann-Whitney U检验分析数据。使用Kaplan-Meier方法分析结局。使用对数秩检验分析存活率差异。老年患者（≥65岁）的中位生存时间明显短于年轻患者（<65岁）（181 vs. 263天，P = 0.0001）。接受化疗的患者的中位生存时间在老年组和年轻组之间没有显著差异（274天vs. 333天，P = 0.09），选择最佳支持治疗的患者的中位生存时间也没有显著差异（84天vs. 78天，P = 0.83）。即使将年轻患者和老年患者之间的年龄界限增加到70岁、75岁和80岁，这些结果仍然成立。接受化疗的老年患者的中位生存时间明显长于选择最佳支持治疗的患者（274 vs. 86 d，P < 0.0001）;老年患者选择最佳支持治疗的比例显著高于年轻患者（47.8%对25.8%，P < 0.0001）。在261例老年患者（82.9%）中确定了选择最佳支持治疗的原因; 133例（51.0%）符合化疗的资格标准，但其中78例（58.6%）未被告知其疾病。并不总是考虑老年患者的治疗偏好;他们通常只接受家庭成员偏好的最佳支持性治疗（N = 65，48.8%），或者因为医生仅根据患者的年龄做出治疗决定（N = 68，51.1%）。化疗对不能切除的老年胰腺癌患者有效，但需要优化治疗以改善预后。
The efficacy of chemotherapy for unresectable pancreatic cancer has improved. However, it is occasionally difficult to make treatment decisions for elderly patients. We reviewed the outcomes of elderly patients with unresectable pancreatic cancer by using a large cohort and evaluated whether they had received chemotherapy and the reason why. Data for 895 pancreatic cancer patients who were treated using chemotherapy or best supportive care were analyzed considering demographics, clinical stage, treatment, and outcome. Data were analyzed using the chi-square test, Student t-test, or Mann-Whitney U-test, as appropriate. Outcomes were analyzed using the Kaplan-Meier method. Differences in survival were analyzed using the log-rank test. The median survival time was significantly shorter in elderly patients (≥65 years) than in younger patients (<65 years) (181 vs. 263 days, P = 0.0001). The median survival time of patients treated with chemotherapy was not significantly different between the elderly and the younger group (274 days vs. 333 days, P = 0.09), and nor was that of patients choosing best supportive care (84 days vs. 78 days, P = 0.83). These results held true even when the age cut-off between younger and elder patients was increased to 70, 75, and 80 years. Elderly patients treated with chemotherapy had a significantly longer median survival time than those choosing best supportive care (274 vs. 86 days, P < 0.0001); a significantly greater proportion of elderly patients chose best supportive care compared to younger patients (47.8 vs. 25.8%, P < 0.0001). The reason for choosing best supportive care was established in 261 elderly patients (82.9%); 133 (51.0%) met the eligibility criteria for chemotherapy, but of these, 78 (58.6%) were not informed about their disease. The treatment preferences of elderly patients were not always considered; they often received only best supportive care per family members preference (N = 65, 48.8%) or because the physician based their treatment decision only on the patient’s age (N = 68, 51.1%). Chemotherapy appears effective for elderly pancreatic cancer patients with unresectable disease, but treatment needs to be optimized to improve prognosis.