吉西他滨联合替吉奥治疗晚期胰腺癌的疗效分析

Efficacy of Gemcitabine and S-1 for Patients with Advanced Pancreatic Cancer

目的探讨吉西他滨联合替吉奥治疗局部晚期和转移性胰腺导管腺癌的疗效和不良反应,以及可能影响患者生存的因素。方法回顾性分析北京协和医院肿瘤内科2014年1月至2017年1月病理确诊并接受吉西他滨联合替吉奥方案(第1、8天吉西他滨1000 mg/m^2静脉滴注30 min;第1~14天口服替吉奥40~60 mg/次,每日2次,每21天为1个周期)一线治疗的胰腺导管腺癌患者的临床资料,所有患者至少接受2周期化疗、有疗效评估和随访资料。结果 60例晚期胰腺癌患者纳入分析,疾病部分缓解13例(22%),稳定37例(61%),进展10例(17%),总体中位无进展生存期7个月(95%CI=6-10),中位总生存期12个月(95%CI=9-20)。单因素分析和多因素分析均显示原发灶切除对无进展生存期、肺转移对总生存期有显著影响。最常见3~4度不良反应为中性粒细胞减少(27%)、白细胞减少(18%)。结论吉西他滨联合替吉奥方案一线治疗晚期胰腺癌有效率较高,不良反应易于管理。

Objective To explore the efficacy and toxicities of gemcitabine combined with S-1 in treating locally advanced and metastatic pancreatic ductal adenocarcinoma and prognostic factors.Methods We retrospectively analyzed the clinical data of patients with locally advanced and metastatic pancreatic cancer receiving gemcitabine and S-1 as first-line therapy in the Department of Medical Oncology,Peking Union Medical College Hospital from January 2014 to January 2017.Gemcitabine was administered at a dose of 1000 mg/m^2 over 30 minutes on days 1 and 8,and oral S-1 at a dose of 40-60 mg twice daily from days 1 to 14,repeated every 3 weeks.All patients received at least two cycles of chemotherapy.Results A total of 60 patients were included,13（22%） achieved partial remission,37（61%） had stable disease,and 10（17%） experienced progressive disease.The median progression-free survival was 7 months（95% CI=6-10 months） and the median overallsurvival was 12 months（95% CI=9-20 months）.Both univariate and multivariate analyses of prognostic factors showed primary resection was significant in predicting shorter progression-free survival and lung metastasis was significant for shorter overall survival.The most common grade 3-4 toxicities were neutropenia（27%） and leukopenia（18%）.Conclusion Gemcitabine combined with S-1 is an effective regimen with manageable toxicities in the treatment of advanced pancreatic cancer and can be used as first-line therapy.