Analysis of Predictors of Resection and Survival in Locally Advanced Stage III Pancreatic Cancer: Does the Nature of Chemotherapy Regimen Influence Outcomes?
Analysis of Predictors of Resection and Survival in Locally Advanced Stage III Pancreatic Cancer: Does the Nature of Chemotherapy Regimen Influence Outcomes?
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DOI：
10.1245/s10434-016-5707-0
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发表时间：
2017-05-01
影响因子：
3.7
通讯作者：
Zureikat, Amer H.
中科院分区：
文献类型：
--
作者：
Bednar, Filip;Zenati, Mazen S.;Zureikat, Amer H.
局部晚期不可切除胰腺癌（LAPC）历来预后较差。FOLFIRINOX和吉西他滨/nab-紫杉醇已被证明对转移性肿瘤有效。我们试图将这些方案与LAPC的旧方案进行比较，以评估其结果。对2010年至2014年所有连续接受“新”（FOLFIRINOX和/或吉西他滨/nab-紫杉醇）和“旧”（吉西他滨或5-FU）化疗的LAPC进行回顾性、单一机构评价。确定了切除和生存的单因素和多因素预测因素。共分析92例患者（新化疗61例，旧化疗31例），其中19例（21%）最终切除（中位总生存期[OS] = 32，未切除患者14.3个月，P = 0.0002）。对于整个队列，多因素分析（MVA）显示，切除（风险比[HR] 0.261, P = 0.014）、放疗（风险比[HR] 0.458, P = 0.004）、化疗线数（风险比[HR] 0.486, P = 0.012）和新化疗（风险比[HR] 0.593, P = 0.065）是OS的独立预测因素。对于MVA，最终切除的预测因子是头颈部肿瘤（OR 0.307, P = 0.033）或SMA受损伤（OR 0.285, P = 0.023）。在未切除的患者（73例）中，MVA显示新化疗（HR 0.452, P = 0.006）、放疗（HR 0.459, P = 0.006）和CT线数（HR 0.705, P = 0.013）是生存的预测因素。在LAPC中，与较老的化疗方案相比，使用FOLFIRNOX和/或吉西他滨/nab-紫杉醇可提高生存率，无论最终是否切除。肿瘤的位置和与某些脉管系统的关系是该队列中切除的重要决定因素。
Locally advanced unresectable pancreatic cancer (LAPC) historically portends a poor prognosis. FOLFIRINOX and gemcitabine/nab-paclitaxel have proven effective in the metastatic setting. We sought to evaluate the outcomes of these regimens compared with older regimens in LAPC.A retrospective, single institutional review of all consecutive LAPC treated with "new" (FOLFIRINOX and/or gemcitabine/nab-paclitaxel) and "old" (gemcitabine or 5-FU) chemotherapy from 2010 to 2014 was performed. Univariate and multivariate predictors of resection and survival were determined.A total of 92 patients (new chemotherapy = 61, old chemotherapy = 31) were analyzed, of which 19 (21%) underwent eventual resection (median overall survival [OS] = 32 vs. 14.3 months for unresected patients, P = 0.0002). For the overall cohort, resection (hazard ratio [HR] 0.261, P = 0.014), radiation therapy (HR 0.458, P = 0.004), number of lines of chemotherapy (HR 0.486, P = 0.012), and new chemotherapy (HR 0.593 vs. old regimens, P = 0.065) were independent predictors of OS on multivariate analyses (MVA). On MVA, predictors of eventual resection were head and neck tumors (OR 0.307, P = 0.033) or SMA involvement (OR 0.285, P = 0.023). In nonresected patients (73), MVA showed treatment with new chemotherapy (HR 0.452, P = 0.006), radiation (HR 0.459, P = 0.006), and number of lines of CT (HR 0.705, P = 0.013) to be predictors of survival.In LAPC, use of FOLFIRNOX and/or gemcitabine/nab-paclitaxel is associated with improved survival compared with older chemotherapy regimens, regardless of eventual resection. Tumor location and relationship to certain vasculature are important determinants of resection in this cohort.