Efficacy and Safety of Metallic Stents in Patients With Unresectable Pancreatic Cancer Receiving Gemcitabine
Efficacy and Safety of Metallic Stents in Patients With Unresectable Pancreatic Cancer Receiving Gemcitabine
复制标题
DOI：
10.1097/mpa.0b013e3181706d93
复制
发表时间：
2008-11-01
期刊：
影响因子：
2.9
通讯作者：
Omata, Masao
中科院分区：
文献类型：
--
作者：
Nakai, Yousuke;Isayama, Hiroyuki;Omata, Masao
目的：可扩张金属支架（EMSs）广泛用于缓解不可切除的恶性胆道梗阻。评估EMS在接受吉西他滨（GEM）治疗不可切除胰腺癌患者中的疗效和安全性。方法：回顾性分析147例不可切除胰腺癌患者的资料：52例接受GEM不加EMS， 36例接受GEM加EMS， 27例只接受最佳支持治疗（BSC）不加EMS， 32例接受BSC加EMS。结果：可膨胀金属支架未增加GEM引起的不良反应（> 2级）（P = 0.809）， GEM和EMS均未增加胆管炎和胆囊炎以外的感染发生率（P = 0.287）。胆管炎和胆囊炎仅发生在EMS患者中，并得到了成功的治疗。肿瘤扩展，良好的表现状态和GEM，而不是EMS，显示影响生存。GEM组26例（72%）和BSC组17例（53%）出现支架相关并发症（P = 0.133）。多变量分析显示没有预测支架相关并发症，尽管使用覆盖EMS和良好的性能状态与较长的支架通畅相关。吉西他滨对支架相关并发症和支架通畅均无影响。结论：可扩张金属支架置入术对于接受GEM治疗的不可切除胰腺癌患者是安全有效的。吉西他滨可提高生存率，与EMS放置无关。
Objectives: Expandable metallic stents (EMSs) are widely used to palliate unresectable malignant biliary obstructions. The efficacy and safety of EMS in patients receiving gemcitabine (GEM) for unresectable pancreatic cancer is evaluated.Methods: Data for 147 patients with unresectable pancreatic cancer were studied retrospectively: 52 received GEM without EMS, 36 received GEM with EMS, 27 received only best supportive care (BSC) without EMS, and 32 received BSC with EMS.Results: Expandable metallic stent did not increase adverse effects (>grade 2) caused by GEM (P = 0.809), and the rates of infections other than cholangitis and cholecystitis were neither increased by GEM nor by EMS (P = 0.287). Cholangitis and cholecystitis occurred exclusively in patients with EMS and was managed successfully. Tumor extension, good performance status, and GEM, but not EMS, were shown to affect survival. Stent-related complications were observed in 26 patients (72%) receiving GEM and in 17 patients (53%) with BSC (P = 0.133). Multivariate analyses revealed no predictors for stent-related complications, although the use of covered EMS and good performance status were associated with longer stent patency. Gemcitabine affected neither stent-related complications nor stent patency.Conclusions: Expandable metallic stent placement is safe and effective in patients with unresectable pancreatic cancer receiving GEM. Gemcitabine improves survival irrespective of EMS placement.