联合铂类化疗改善晚期胰腺癌预后

Chemotherapy combined with platinum prolongs survival of patients with advanced pancreatic cancer

目的探讨治疗晚期胰腺癌的有效药物。方法选择病理诊断明确的Ⅲ～Ⅳ期胰腺癌患者,至少接受2周期以上吉西他滨、氟尿嘧啶及铂类化疗,电话回访生存期,分析不同药物治疗后生存期变化。结果 95例晚期胰腺癌患者中位生存期7.1月,1年生存率30.5%,2年生存率8.4%,3年生存率3.2%。Cox单因素生存模型分析显示,Ⅳ期患者较Ⅲ期患者生存期短(P=0.002,HR:2.09,95%CI:1.31～3.35),联合铂类化疗方案治疗患者较未联合患者生存期长(P=0.011,HR:0.56,95%CI:0.35～0.88),胰体尾癌较胰头颈部癌患者生存期有缩短趋势,但差异无统计学意义(P=0.062,HR:1.53,95%CI:0.98～2.38)。Cox多因素生存模型分析显示,Ⅳ期患者较Ⅲ期患者死亡风险增加(P=0.026,HR:1.83,95%CI:1.08～3.10),联合铂类化疗能降低晚期胰腺癌死亡风险(P=0.026,HR:0.59,95%CI:0.38～0.94)。结论Ⅳ期胰腺癌患者较Ⅲ期患者预后差,联合铂类化疗可能延长晚期胰腺癌生存期。

Objective To evaluate the efficacy of chemotherapy combined with platinum for patients with advanced pancreatic cancer. Methods Patients with stage Ⅲ and Ⅳ pancreatic cancer received at least 2 cycles of gemcitabine and/or fluorouracil regimens.The survival of patients was analyzed with Cox regression analysis. Results The median survival time of 95 patients was 7.1 months,the one-,two-and three-year survival rates were 30.5%,8.4% and 3.2%,respectively.Cox monopolar proportional hazards model analysis found that patients with stage Ⅳcancer had significantly less survival than those with stage Ⅲ（P=0.002,HR： 2.09,95% CI： 1.31~3.35）.Patients receiving chemotherapy regimens including platinum had longer survival than those not including platinum（P=0.011,HR： 0.56,95% CI： 0.35~0.88）.Patients with pancreatic body and tail tumors tended to have less survival than those with pancreatic head and neck tumors,but there was no statistical difference（P=0.062,HR： 1.53,95% CI： 0.98~2.38）.Cox multivariate proportional hazards model analysis found that a higher mortality risk in stage Ⅳ patients（P=0.026,HR： 1.83,95% CI： 1.08~3.10） and a lower mortality risk in patients receiving chemotherapy regimens including platinum（P=0.026,HR： 0.59,95% CI： 0.38~0.94）. Conclusions Tumor stage is an independent prognostic factor for pancreatic cancer.chemotherapy combined with platinum regimens may prolong survival of patients with advanced pancreatic cancer.