Prognostic factors for survival in pancreatic cancer: a population-based study
Prognostic factors for survival in pancreatic cancer: a population-based study
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DOI：
10.1016/j.amjsurg.2006.02.017
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发表时间：
2006-09-01
影响因子：
3
通讯作者：
Vickers, Selwyn M.
中科院分区：
文献类型：
--
作者：
Eloubeidi, Mohamad A.;Desmond, Renee A.;Vickers, Selwyn M.
工作背景：我们对来自美国南部腹地（黑人居民> 25%）的患者进行了一项基于人群的研究，以评估胰腺癌患者的生存率。我们的目的是分析预后因素影响胰腺癌生存率使用人口为基础的亚拉巴马全州癌症登记处，并确定是否种族/民族是一个独立的决定因素的结果在patients with pancreatic cancer.Methods：符合条件的参与者包括所有的人诊断为胰腺癌从1996年至2000年，并报告给亚拉巴马全州癌症登记处。对于胰腺癌死亡，计算从诊断时间至死亡的生存时间，对于删失的受试者，计算从最后一次联系日期或其他原因死亡的生存时间。采用Kaplan-Meier生存法和log-rank检验评估与生存相关的危险因素。人口统计学，肿瘤和治疗变量进行了评估，使用考克斯比例风险model.Results：2230例患者，诊断时的中位年龄为71岁，男性与女性的比例约为1：1。73%的患者是白色，27%的患者是黑人。分期分布为12.5%局限性疾病，29.6%区域性，35.3%远处，22.6%未分期。所有患者的中位生存时间为0.39 +/-0.01年。接受手术治疗的患者不太可能死于胰腺癌（风险比，0.48; 95%置信区间，0.41 -56）。同样，接受化疗或放疗的患者的生存率也有所提高（风险比，0.62; 95%置信区间，0.53 -73）。在所有分期中，黑人患者接受化疗的可能性明显低于白色患者（26.7% vs 32.3%，P = 0.02），接受手术干预的可能性也较低（14.02% vs 17.0%，P = 0.09）。当检查那些被提供选择治疗但拒绝的患者时，我们发现在所有阶段，黑人患者拒绝治疗的比例高于白人：化疗为5.6%对2.9%（P = 0.02），放疗为3.8%对1.6%（P = 0.04），手术为9.0%对3.3%（P = 0.001）。考克斯比例风险模型显示，种族对总生存时间没有影响，而控制在介绍阶段，接受的治疗类型，诊断时的年龄，和原发tumor.Conclusions：胰腺癌患者的生存仍然令人沮丧。肿瘤特征和治疗因素与胰腺癌患者的生存时间直接相关。黑人患者不太可能接受治疗，但也更有可能拒绝指定的治疗。导致胰腺癌治疗中种族差异的因素需要进一步研究。(c)2006 Excerpta Medica Inc. All rights reserved.
Background: We performed a population-based study of patients from the deep South of the United States (with > 25% black residents) to evaluate the survival rate of patients with pancreatic cancer. Our aims were to analyze prognostic factors influencing pancreatic cancer survival using the population-based Alabama Statewide Cancer Registry and to determine whether race/ethnicity is an independent determinant of outcomes in patients with pancreatic cancer.Methods: Eligible participants included all persons diagnosed with pancreatic cancer from 1996 to 2000 and reported to the Alabama Statewide Cancer Registry. Survival time was calculated from time of diagnosis to death for pancreatic cancer deaths or to date of last contact or death from other causes for censored participants. Risk factors associated with survival were assessed with the Kaplan-Meier survival method and the log-rank test. Demographic, tumor, and treatment variables were assessed using the Cox proportional hazards model.Results: Of 2230 patients, the median age at diagnosis was 71 years and the male to female ratio was approximately 1:1. Seventy-three percent of patients were white, and 27% of patients were black. The distribution by stage was 12.5% localized disease, 29.6% regional, 35.3% distant, and 22.6% unstaged. The median survival time for all patients was .39 +/-.01 years. Patients who underwent surgical treatment were less likely to die of pancreatic cancer (hazard ratio, .48; 95% confidence interval, .41-56). Similarly, patients who underwent either chemotherapy or radiation therapy had improved survival rates (hazard ratio, .62; 95% confidence interval, .53-73). Across all stages, black patients were significantly less likely to receive chemotherapy compared with white patients (26.7% vs 32.3%, P = .02), and were less likely to receive surgical intervention (14.02% vs 17.0%, P = .09). When examining patients who were offered their therapy of choice but refused, we found across all stages that a greater proportion of black patients refused therapies versus whites: 5.6% versus 2.9% (P = .02) for chemotherapy, 3.8% versus 1.6% (P = .04) for radiation, and 9.0% versus 3.3% (P = .001 for surgery). The Cox proportional hazard model showed no effect of race on overall survival time while controlling for stage at presentation, type of therapy received, age at diagnosis, and site of primary tumor.Conclusions: Survival in patients with pancreatic cancer remains dismal. Tumor characteristics and treatment factors are related directly to survival time in patients with pancreatic cancer. Black patients were less likely to receive therapy but also were more likely to refuse the indicated therapy. Factors leading to racial disparity in the treatment of pancreatic cancer warrant further investigation. (c) 2006 Excerpta Medica Inc. All rights reserved.