Management of pancreatic cancer in the elderly
Management of pancreatic cancer in the elderly
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DOI：
10.3748/wjg.v22.i2.764
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发表时间：
2016-01-14
影响因子：
4.3
通讯作者：
Feliu, Jaime
中科院分区：
文献类型：
--
作者：
Higuera, Oliver;Ghanem, Ismael;Feliu, Jaime
目前，胰腺癌主要发生在60岁以后，尽管近几十年来有所改善，但其预后仍然较差。人口老龄化将导致未来几年胰腺癌发病率上升。因此，老年人胰腺癌的治疗变得越来越重要。老年癌症患者是一个异质群体，具有不同的生物学、功能和社会心理特征，这些特征可以改变这种疾病的常规治疗，包括药代动力学和药效学变化、多药治疗、体能状态、合并症和器官功能障碍。然而，患者的生物学年龄，而不是实际年龄，应该成为确定这些患者最合适治疗的限制因素。不幸的是，尽管老年患者中这种病理的发生率有所增加，但这些患者在临床试验中的代表性不足，因此老年患者的治疗是通过从年轻患者中进行的研究结果推断来确定的。本综述将讨论老年人的特殊特征、局限性晚期胰腺导管腺癌的多学科治疗以及该病治疗的最新进展，重点是手术、化疗、放疗和姑息治疗。
Currently, pancreatic adenocarcinoma mainly occurs after 60 years of age, and its prognosis remains poor despite modest improvements in recent decades. The aging of the population will result in a rise in the incidence of pancreatic adenocarcinoma within the next years. Thus, the management of pancreatic cancer in the elderly population is gaining increasing relevance. Older cancer patients represent a heterogeneous group with different biological, functional and psychosocial characteristics that can modify the usual management of this disease, including pharmacokinetic and pharmacodynamic changes, polypharmacy, performance status, comorbidities and organ dysfunction. However, the biological age, not the chronological age, of the patient should be the limiting factor in determining the most appropriate treatment for these patients. Unfortunately, despite the increased incidence of this pathology in older patients, there is an underrepresentation of these patients in clinical trials, and the management of older patients is thus determined by extrapolation from the results of studies performed in younger patients. In this review, the special characteristics of the elderly, the multidisciplinary management of localized and advanced ductal adenocarcinoma of the pancreas and the most recent advances in the management of this condition will be discussed, focusing on surgery, chemotherapy, radiation and palliative care.