转移性十二指肠腺癌化疗方案的疗效及患者预后影响因素

Efficacy of chemotherapy and prognostic factors in patients with metastatic duodenal adenocarcinoma

目的:评价不同化疗方案一线治疗转移性十二指肠腺癌的疗效和患者预后因素。方法:56例转移性十二指肠腺癌患者根据一线化疗方案的不同将其分为氟尿嘧啶类单药组(A组),氟尿嘧啶类联合奥沙利铂组(B组),氟尿嘧啶类联合伊立替康组(C组),吉西他滨联合奥沙利铂组(D组),观察各组患者化疗疗效和生存时间。结果:A组患者有效率(ORR)为16.7%,无病生存时间(PFS)4.9个月,总生存时间(OS)10.6个月;B组ORR为36.8%,PFS 6.3个月,OS 13.2个月;C组ORR为20%,PFS 4.1个月,OS 10.4个月;D组ORR为38.1%,PFS 7.5个月,OS 15.3个月。各组间ORR、PFS、OS比较为差异均无统计学意义(P>0.05)。不同ECOG评分、基线CA199水平和化疗近期疗效间的PFS差异有统计学意义(P<0.05),而不同ECOG评分、既往有无手术治疗及基线CEA和CA199水平间的OS差异有统计学意义(P<0.05)。结论:各组化疗方案治疗转移性十二指肠腺癌疗效差异无统计学意义,两药方案似乎更具优势。ECOG评分、CA199和化疗近期疗效为PFS独立预后因素,而ECOG评分、CEA、CA199及既往有无手术治疗为OS独立预后因素。

Objective To investigate the efficacy of different first-line chemotherapy regimens in metastatic duodenal adenocarcinoma, and the potential prognostic factors. Methods According to first-line chemotherapy regimens,fifty-six patients with metastatic duodenal adenocarcinoma were enrolled into four groups： fluoropyrimidine monotherapy （group A）, fluoropyrimidine-oxaliplatin （group B）, fluoropyrimidine-irinotecan （group C）, gemcitabine-oxaliplatin （group D）. The efficacy and survival time of each patient were detected. Results In group A, the objective response rate（ORR） was 16.7%, the median progression free survival（PFS） was 4.9 months and the overall survival（OS） was 10.6 months. However, in group B, the ORR was 36.8%, the PFS was 6.3 months and the OS was 13.2 months. In group C, the ORR was 20%, the PFS was 4.1 months and the OS was 10.4 months. In group D, the ORR was 38.1%, the PFS was 7.5 months and the OS was 15.3 months. No significant differences of ORR, PFS and OS were observed among three groups（P 〉 0.05）. Resuhs of multivariate analysis showed significant differences of PFS were found among ECOG performance status, baseline CA199 and tumor response （P 〈 0.05）, and significant differences of OS were found among ECOG performance status, surgery history, baseline CA199 and baseline CEA （P 〈 0.05）. Conclusions Two-drug combination chemotherapy regimens has good efficacy, but with no significant difference. ECOG performance status, baseline CA199 level and tumor response were independent prognostic factors for PFS. And ECOG performance status, the baseline CEA level, the baseline CA199 level and surgery history were independent prognostic factors for OS.