晚期胰腺癌患者的临床特征及预后分析

doi:10.3969/j.issn.1006-7795.2023.03.022

摘要/Abstract

摘要： 目的探索了解晚期胰腺癌患者的临床特征和生存情况，并分析预后影响因素。方法纳入2017年1月至2020年12月就诊于首都医科大学附属北京朝阳医院肿瘤科的晚期胰腺癌患者共55例，收集病历资料并进行随访。采用Kaplan-Meier法和Log rank检验进行总生存期（overall survival, OS）、无进展生存期（progression free survival, PFS）分析，采用比例风险回归模型（proportional hazards model，简称Cox）进行多因素分析。结果中位随访时间55.3个月，中位OS为7.7个月，6个月、1年、2年生存率分别为61.8%、34.0%和11.6%。有无一线治疗、美国东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）评分、有无手术、有无肝转移及糖类抗原19-9（carbohydrate antigen19-9,CA19-9）是OS的影响因素。ECOG评分、有无肝转移、CA19-9、一线治疗疗效和有无感染发生是影响一线PFS的影响因素。结论晚期胰腺癌进行一线治疗至关重要，根据患者身体状况及患者临床病理特征选择适合患者的最佳治疗方案，不同治疗方案之间对预后影响的差异无统计学意义。建议患者完善二代基因测序（next generation sequencing，NGS）检查，如有机会进行靶向及免疫治疗，可以更好地延长晚期胰腺癌患者的生存期。

关键词: 晚期胰腺癌, 临床特征, 预后因素

Abstract: Objective To explore the clinical features and survival of patients with metastatic pancreatic cancer in the real world, and analyze the prognostic factors. Methods A total of 55 patients admitted to Beijing Chaoyang Hospital, Capital Medical University from January 2017 to December 2020 were collected. SPSS 27.0 was used for overall survival (OS) and progression free survival (PFS) analysis by Kaplan-Meier method and Log rank test, and Cox regression model was used for multivariate analysis. Results The median follow-up time was 55.3 months. We found that the median OS was 7.7 months, with 6-month, 1-year, and 2-year overall survival rates of 61.8%, 34.0% and 11.6%, respectively. First line therapy, Eastern Cooperative Oncology Group （ECOG） score, liver metastasis, pancreatectomy and carbohydrate antigen19-9 （CA19-9） value were significant prognostic factors for OS, and ECOG score, liver metastasis, CA19-9 value, efficacy and infection were significant prognostic factors for PFS in first line therapy. Conclusion It is very important to take first line therapy for metastatic pancreatic cancer. We recommend selecting a more suitable treatment plan for patients based on their physical condition and clinical pathological characteristics. Our findings suggest that there is no significant difference in prognosis between different regimens. Next generation sequencing （NGS） examination is recommended for patients with metastatic pancreatic cancer, if targeting and immunotherapy opportunities are available to prolong survival.

Key words: metastatic pancreatic cancer, clinical characteristics, prognostic factors

中图分类号:

R735

郭继红, 朱宁, 葛洋, 安广宇. 晚期胰腺癌患者的临床特征及预后分析[J]. 首都医科大学学报, 2023, 44(3): 501-506.

Guo Jihong, Zhu Ning, Ge Yang, An Guangyu. Clinical characteristic and prognostic analysis of patients with metastatic pancreatic cancer[J]. Journal of Capital Medical University, 2023, 44(3): 501-506.

参考文献

［1］蔡洁, 陈宏达, 卢明, 等. 2005－2015年中国胰腺癌发病与死亡趋势分析［J］. 中华流行病学杂志, 2021, 42(5): 794－800.
［2］郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析［J］. 中华肿瘤杂志, 2019, 41(1): 19－28.
［3］Rahib L, Smith B D, Aizenberg R, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States［J］. Cancer Res, 2014, 74(11): 2913－2921.
［4］Siegel R L, Miller K D, Fuchs H E, et al. Cancer statistics, 2022［J］. CA Cancer J Clin, 2022, 72(1): 7－33.
［5］Xia C F, Dong X S, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants［J］. Chin Med J (Engl), 2022, 135(5): 584－590.
［6］Hecht J R, Lonardi S, Bendell J, et al. Randomized phase Ⅲ study of FOLFOX alone or with pegilodecakin as second-line therapy in patients with metastatic pancreatic cancer that progressed after gemcitabine (SEQUOIA)［J］. J Clin Oncol, 2021, 39(10): 1108－1118.
［7］Renouf D J, Knox J J, Kavan P, et al. LBA65 The Canadian Cancer Trials Group PA.7 trial: results of a randomized phase Ⅱ study of gemcitabine (GEM) and nab-paclitaxel (Nab-P) vs GEM, nab-P, durvalumab (D) and tremelimumab (T) as first line therapy in metastatic pancreatic ductal adenocarcinoma (mPDAC)［J］. Ann Oncol, 2020, 31(Suppl 4): S1195.
［8］Lambert A, Schwarz L, Borbath I, et al. An update on treatment options for pancreatic adenocarcinoma［J］. Ther Adv Med Oncol, 2019, 11: 1758835919875568.
［9］Hegewisch-Becker S, Aldaoud A, Wolf T, et al. Results from the prospective German TPK clinical cohort study: treatment algorithms and survival of 1,174 patients with locally advanced, inoperable, or metastatic pancreatic ductal adenocarcinoma［J］. Int J Cancer, 2019, 144(5): 981－990.
［10］Burris H A 3rd, Moore M J, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial［J］. J Clin Oncol, 1997, 15(6): 2403－2413.
［11］De Dosso S, Siebenhüner A R, Winder T, et al. Treatment landscape of metastatic pancreatic cancer［J］. Cancer Treat Rev, 2021, 96: 102180.
［12］Ettrich T J, Seufferlein T. Systemic therapy for metastatic pancreatic cancer［J］. Curr Treat Options Oncol, 2021, 22(11): 106.
［13］Vaccaro V, Sperduti I, Milella M. Folfirinox versus gemcitabine for metastatic pancreatic cancer［J］. N Engl J Med, 2011, 365(8): 768－769.
［14］Von Hoff D D, Ervin T, Arena F P, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine［J］. N Engl J Med, 2013, 369(18): 1691－1703.
［15］Heinemann V, Boeck S, Hinke A, et al. Meta-analysis of randomized trials: evaluation of benefit from gemcitabine-based combination chemotherapy applied in advanced pancreatic cancer［J］. BMC Cancer, 2008, 8: 82.
［16］Golan T, Hammel P, Reni M, et al. Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer［J］. N Engl J Med, 2019, 381(4): 317－327.
［17］Pishvaian M J, Blais E M, Brody J R, et al. Overall survival in patients with pancreatic cancer receiving matched therapies following molecular profiling: a retrospective analysis of the Know Your Tumor registry trial［J］. Lancet Oncol, 2020, 21(4): 508－518.
［18］Michaud D S. Role of bacterial infections in pancreatic cancer［J］. Carcinogenesis, 2013, 34(10): 2193－2197.
［19］刘阳, 张智勇, 黎一鸣, 等. 胆管恶性肿瘤患者胆汁细菌学分析［J］. 现代肿瘤医学, 2013, 21(4): 814－816.

[1]	尹雪, 于明航, 王玺, 陈京龙. 肝癌中SWI/SNF复合物突变与免疫检查点抑制剂治疗应答反应的研究进展[J]. 首都医科大学学报, 2023, 44(5): 768-774.
[2]	宁婷婷, 王照情, 张楠, 朱圣韬. ACE2在结肠癌中表达的临床意义及结肠癌细胞对以ACE2为受体的三种人冠状病毒的易感性分析[J]. 首都医科大学学报, 2023, 44(4): 663-668.
[3]	郭春梅, 刘红, 焦月, 张倩, 王沧海, 王亚丹, 蔺武, 魏南, 张澍田, 吴静. 结直肠癌术后患者异时性进展期腺瘤风险筛查模型的构建及验证[J]. 首都医科大学学报, 2023, 44(2): 295-301.
[4]	孙婧, 史幼梧, 杜丰, 杨颖, 孙志伟, 余靖, 肖艳洁, 张晓东, 贾军. 消化道肿瘤免疫相关不良事件的临床分析[J]. 首都医科大学学报, 2023, 44(2): 343-350.
[5]	李荣雪, 张倩, 邢洁, 孙秀静, 李鹏, 焦月, 张澍田. 超声内镜对早期结直肠癌的诊断价值分析[J]. 首都医科大学学报, 2023, 44(1): 126-130.
[6]	邵琳琳, 朱思莹, 邢洁, 武珊珊, 朱圣韬, 张澍田. 原发性胃肠道淋巴瘤的临床特征和内镜特点分析[J]. 首都医科大学学报, 2022, 43(2): 205-209.
[7]	李雪, 邢洁, 张倩, 李鹏, 吕富靖, 张澍田. 窄带成像技术联合放大内镜JES分型对早期食管癌的诊断价值[J]. 首都医科大学学报, 2022, 43(2): 210-215.
[8]	孙婧, 史幼梧, 贾军, 杨颖, 孙志伟, 杜丰, 余靖, 肖艳洁, 张晓东. 血液炎症相关指标在晚期胰腺癌中的预后价值[J]. 首都医科大学学报, 2022, 43(2): 299-304.
[9]	孙灿, 邢洁, 张希, 孙秀静, 张澍田. 内镜下黏膜剥离术治疗低位直肠早癌的临床分析[J]. 首都医科大学学报, 2022, 43(1): 34-37.
[10]	马宗慧, 张倩, 邢洁, 朱圣韬, 李鹏, 张澍田, 孙秀静. 早期胃癌内镜下治疗的非治愈性切除率及影响因素[J]. 首都医科大学学报, 2022, 43(1): 17-21.
[11]	程芮, 朱思莹, 刘思茂, 周艳华, 宗晔, 李鹏, 张澍田. 内镜下治疗食管胃底静脉曲张伴发上消化道肿物的经验[J]. 首都医科大学学报, 2022, 43(1): 22-27.
[12]	何振, 刘娟, 冀明, 李鹏, 张澍田. 内镜下黏膜剥离术治疗累及肛门齿状线直肠病变的临床效果评价[J]. 首都医科大学学报, 2022, 43(1): 38-41.
[13]	杨怿, 李雪, 程芮, 陈炜, 陈楚岩, 张澍田. 消化道早癌内镜成像技术的研究进展[J]. 首都医科大学学报, 2022, 43(1): 47-52.
[14]	司海, 刘然, 熊中原, 曹邦伟. 细胞角蛋白的表达水平与结直肠癌临床病理学特征的相关性研究[J]. 首都医科大学学报, 2022, 43(1): 127-131.
[15]	安松林, 马玲, 赵月, 李雁. 主要促进因子超家族成员MFSD2A对肝癌细胞增殖、凋亡和侵袭的影响[J]. 首都医科大学学报, 2021, 42(6): 1000-1006.