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Abstract：
Primary tumor resection (PTR) as a treatment option for patients with stage IV pancreatic cancer (PC) is controversial.
Stage IV PC patients, with treatment data from the National Cancer Institute\'s Surveillance, Epidemiology, and End Results (SEER), were screened. The main outcomes were overall survival (OS) and cancer-specific survival (CSS).
We enrolled 15,836 stage IV PC patients in this study. Propensity score-matched analyses revealed improved OS and CSS of patients receiving chemotherapy plus PTR versus chemotherapy (median survival time [MSTOS ]: 13 vs. 9 months, p = 0.024; MSTCSS : 14 vs. 10 months, p = 0.035), and chemoradiotherapy plus PTR versus chemoradiotherapy (MSTOS : 14 vs. 7 months, p = 0.044; MSTCSS : 14 vs. 7 months, p = 0.066). Multivariate adjusted analyses further confirmed these results. Stratified with different metastatic modalities, multivariate analyses suggested that PTR significantly improved the OS and CSS among patients with ≤1 metastatic organ, and that patients with brain metastasis might not benefit from chemotherapy treatment.
PTR improves the OS and CSS of stage IV PC patients on the basis of chemotherapy or chemoradiotherapy, provided that the metastases involve ≤1 organ. Chemotherapy, however, should be carefully considered in patients with metastases involving the brain.
Stage IV PC patients, with treatment data from the National Cancer Institute\'s Surveillance, Epidemiology, and End Results (SEER), were screened. The main outcomes were overall survival (OS) and cancer-specific survival (CSS).
We enrolled 15,836 stage IV PC patients in this study. Propensity score-matched analyses revealed improved OS and CSS of patients receiving chemotherapy plus PTR versus chemotherapy (median survival time [MSTOS ]: 13 vs. 9 months, p = 0.024; MSTCSS : 14 vs. 10 months, p = 0.035), and chemoradiotherapy plus PTR versus chemoradiotherapy (MSTOS : 14 vs. 7 months, p = 0.044; MSTCSS : 14 vs. 7 months, p = 0.066). Multivariate adjusted analyses further confirmed these results. Stratified with different metastatic modalities, multivariate analyses suggested that PTR significantly improved the OS and CSS among patients with ≤1 metastatic organ, and that patients with brain metastasis might not benefit from chemotherapy treatment.
PTR improves the OS and CSS of stage IV PC patients on the basis of chemotherapy or chemoradiotherapy, provided that the metastases involve ≤1 organ. Chemotherapy, however, should be carefully considered in patients with metastases involving the brain.
摘要：
背景：原发性肿瘤切除术（PTR）作为IV期胰腺癌（PC）患者的治疗选择是有争议的。
方法：IV期PC患者，根据国家癌症研究所监测的治疗数据，流行病学,和最终结果(SEER)，被筛选。主要结果是总生存率（OS）和癌症特异性生存率（CSS）。
结果：我们在这项研究中招募了15,836名IV期PC患者。倾向评分匹配分析显示，接受化疗加PTR与化疗的患者的OS和CSS改善（中位生存时间[MSTOS]：13vs.9个月,p=0.024；MSTCSS：14vs.10个月,p=0.035),放化疗加PTR与放化疗（MSTOS：14与7个月,p=0.044；MSTCSS：14vs.7个月,p=0.066)。多变量调整分析进一步证实了这些结果。用不同的转移方式分层，多变量分析表明PTR显著改善了≤1个转移器官患者的OS和CSS,脑转移患者可能无法从化疗中获益。
结论：PTR在化疗或放化疗的基础上改善了IV期PC患者的OS和CSS，前提是转移涉及≤1个器官。化疗,然而,对于涉及脑的转移瘤患者，应仔细考虑。
方法：IV期PC患者，根据国家癌症研究所监测的治疗数据，流行病学,和最终结果(SEER)，被筛选。主要结果是总生存率（OS）和癌症特异性生存率（CSS）。
结果：我们在这项研究中招募了15,836名IV期PC患者。倾向评分匹配分析显示，接受化疗加PTR与化疗的患者的OS和CSS改善（中位生存时间[MSTOS]：13vs.9个月,p=0.024；MSTCSS：14vs.10个月,p=0.035),放化疗加PTR与放化疗（MSTOS：14与7个月,p=0.044；MSTCSS：14vs.7个月,p=0.066)。多变量调整分析进一步证实了这些结果。用不同的转移方式分层，多变量分析表明PTR显著改善了≤1个转移器官患者的OS和CSS,脑转移患者可能无法从化疗中获益。
结论：PTR在化疗或放化疗的基础上改善了IV期PC患者的OS和CSS，前提是转移涉及≤1个器官。化疗,然而,对于涉及脑的转移瘤患者，应仔细考虑。
