胰腺癌非手术患者治疗模式与预后——单中心230例回顾性研究  

Treatment modality and prognosis of non-surgical pancreatic cancer:A single-center retrospective analysis of 230 cases

作　　者：曹必样 张乐天 吴陈陈 杨微[2] 刘小亮[2] 王倩倩[2] 王竞[2] CAO Biyang;ZHANG Letian;WU Chenchen;YANG Wei;LIU Xiaoliang;WANG Qianqian;WANG Jing(Chinese PLA Medical School,Beijing 100853,China;Department of Radiation Oncology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心放疗科,北京100853

出　　处：《解放军医学院学报》2023年第5期445-452,共8页Academic Journal of Chinese PLA Medical School

基　　金：国家重点研发计划(2017YFC0112100)。

摘　　要：背景胰腺癌非手术患者的主要治疗手段仍是以放化疗为主的综合治疗,但其最佳治疗模式及疗效尚不明确。目的分析接受基于放疗的综合治疗的胰腺癌非手术患者临床病理特征、治疗模式及预后。方法分析2016年1月-2020年12月解放军总医院第一医学中心放疗科收治的230例接受基于放疗的综合治疗的胰腺癌非手术患者(医学上不能手术切除或不适合手术)。Kaplan-Meier法计算中位总生存期(median overall survival,mOS)和中位无进展生存期(median progression-free survival,mPFS)。Cox风险比例模型分析影响患者生存的独立预后因素。结果230例患者中,男140例,女90例,中位年龄64(33~88)岁。全组患者中位随访时间19.9个月(95%CI:18.2~27.7个月),mOS和mPFS分别为17.1个月和10.3个月,1年、2年、3年、4年和5年OS分别为68.1%、30.0%、16.0%、4.9%和2.5%。局限期(Ⅰ/Ⅱ期)、局部晚期(Ⅲ期)和转移性(Ⅳ期)胰腺癌患者mOS分别为21.1个月、17.0个月和14.1个月,mPFS分别为14.0个月、12.7个月和6.9个月。在局限期患者中,单纯放疗(radiotherapy,RT)组与放化疗联合(combined-modality therapy,CMT)组mOS无统计学差异(21.1个月vs 19.3个月,P=0.620);在局部晚期和转移性患者中CMT组mOS显著优于RT组(局部晚期:19.2个月vs 11.6个月,P=0.003;转移:15.7个月vs 8.0个月,P=0.017)。CMT组患者亚组分析显示,诱导化疗后放疗再巩固化疗(CT-RT-CT)组、化疗序贯放疗(CT-RT)组和放疗序贯化疗(RT-CT)组mOS分别为23.1个月、16.4个月、18.0个月(P=0.007),且在局部晚期患者中mOS有统计学差异(25.5个月vs 16.4个月和18.0个月,P=0.034)。临床分期、基线CA19-9、治疗模式和放疗部位与患者生存独立相关(P均<0.05)。结论现代放化疗综合治疗背景下胰腺癌非手术患者整体生存明显改善。对于局限期患者,单纯放疗与放化疗联合的疗效相似,提示现代放疗可作为根治性治疗的可选治疗手段。对于局部�Background Comprehensive treatment remains the primary treatment for patients with non-surgical pancreatic cancer,but the optimal treatment modality and outcome are unclear.Objective To analyze the clinicopathological characteristics,treatment modality and prognosis of non-surgical patients receiving radiotherapy-based comprehensive treatment for pancreatic cancer.Methods From January 2016 to December 2020,a total of 230 medically unfit or inoperable pancreatic cancer patients treated with radiotherapy-based comprehensive treatment were enrolled.The median overall survival(mOS)and progression-free survival(mPFS)rates were calculated using the Kaplan-Meier method.Independent prognostic factors were identified by Cox proportional harzard model.Results There were 140 males and 90 females,with a median age of 64 years(range,33 to 88 years).With a follow-up time of 19.9 months.The mOS and mPFS were 17.1 months and 10.3 months,respectively.The 1-year,2-year,3-year,4-year and 5-year OS were 68.1%,30.0%,16.0%,4.9%and 2.5%,respectively.In patients with localized,locally advanced,and metastatic pancreatic cancer,the median OS were 21.1,17.0 and 14.1 months,and the mPFS was 14.0,12.7 and 6.9 months,respectively.There was no significant difference in mOS of patients with localized stage treated with radiotherapy alone(RT)and combined-modality therapy(CMT)(21.1 months vs 19.3 months,P=0.620).Compared with the RT group,the CMT group demonstrated better survival in patients with locally advanced (19.2 vs 11.6 months, P=0.003) and metastatic pancreatic cancer (15.7 months vs 8.0 months, P=0.017). Subgroup analysis of patients in the CMT group showed that the mOS in the induction chemotherapy followed by radiotherapy and consolidation chemotherapy (CT-RT-CT) group, chemotherapy followed by radiotherapy (CT-RT) group and radiotherapy followed by chemotherapy (RT-CT) group were 23.1 months, 16.4 months and 18.0 months, respectively (P=0.007). There was a significant difference in survival of patients with locally advanced stage in

关 键 词：胰腺癌 非手术 放化疗 治疗模式 生存结局 

分 类 号：R735.9[医药卫生—肿瘤]