Duodenal stenting followed by systemic chemotherapy for patients with pancreatic cancer and gastric outlet obstruction
Duodenal stenting followed by systemic chemotherapy for patients with pancreatic cancer and gastric outlet obstruction
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DOI：
10.1016/j.pan.2016.07.007
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发表时间：
2016-11-01
期刊：
影响因子：
3.6
通讯作者：
Morimoto, Manabu
中科院分区：
文献类型：
--
作者：
Kobayashi, Satoshi;Ueno, Makoto;Morimoto, Manabu
目的：内镜下十二指肠支架置入术最近被提出作为手术胃空肠造口术的替代方法来治疗胃出口梗阻。我们的目的是评估晚期胰腺癌胃出口梗阻患者十二指肠支架置入术后全身化疗的有效性和安全性。方法：这是一项在学术医学中心进行的单中心、回顾性队列研究，研究对象为71例晚期胰腺癌和胃出口梗阻患者（平均年龄：67.6岁；范围：31-92岁），这些患者接受了十二指肠支架术，并伴有或不伴有化疗。评估总生存期、口服食物摄入时间、化疗引入率、无进展生存期和不良事件。结果：69例（97%）患者支架置入术成功。36例（51%）患者接受化疗：17例单独使用吉西他滨，15例单独使用S-1, 3例使用FOLFIRINOX， 1例使用紫杉醇。化疗后的中位无进展生存期和总生存期分别为2.6个月（95%可信区间：13-3.9个月）和4.7个月（95%可信区间：2.6-6.8个月）。十二指肠支架植入术后化疗期间经常出现3级贫血（32%）。肿瘤分期、功能状态、中性粒细胞与淋巴细胞比值和化疗引入是影响生存的独立预后因素(风险比分别为3.73、2.21、2.69和1.85，p值分别为
Objectives: Endoscopic duodenal stenting has recently been proposed as a substitute for surgical gastrojejunostomy for the treatment of gastric outlet obstruction. We aimed to evaluate the efficacy and safety of duodenal stenting followed by systemic chemotherapy for patients with advanced pancreatic cancer with gastric outlet obstruction.Methods: This was a single-center, retrospective cohort study, conducted at an academic medical center, of 71 patients with advanced pancreatic cancer and gastric outlet obstruction (mean age: 67.6 years; range: 31-92 years) who underwent duodenal stenting with or without subsequent chemotherapy. Overall survival, duration of oral intake of foods, the rate of introduction of chemotherapy, progression free survival, and adverse events were evaluated.Results: Stent placement was technically successful in 69 (97%) patients. Thirty-six (51%) patients were treated with chemotherapy: 17 with gemcitabine alone, 15 with S-1 alone, 3 with FOLFIRINOX, and 1 with paclitaxel. Median progression-free survival and overall survival after chemotherapy were 2.6 months (95% confidence interval: 13-3.9 months) and 4.7 months (95% confidence interval: 2.6-6.8 months), respectively. Cases of grade 3 anemia were frequently observed during chemotherapies following duodenal stenting (32%). Tumor stage, performance status, neutrophil-to-lymphocyte ratio, and introduction of chemotherapy were independent prognostic factors for survival (hazard ratios of 3.73, 2.21, 2.69, and 1.85 with p-values of