背景:早发性胰腺癌(EOPC;诊断时年龄≤50岁)的发病率正在上升,给个人带来沉重的负担,家庭,和社会。包括手术在内的联合治疗的作用,放射治疗,非转移性EOPC的化疗尚不明确。
目的:探讨非转移性EOPC患者的治疗模式和生存结局。
方法:对2017年至2021年在我院接受治疗的277例非转移性EOPC患者进行回顾性调查。总生存期(OS),无病生存,无进展生存期采用Kaplan-Meier方法进行估计.使用Cox比例风险模型的单变量和多变量分析来识别预后因素。
结果:中位随访时间为34.6个月,1年,2年,整个队列的3年OS率为84.3%,51.5%,和27.6%,分别。单纯手术和辅助治疗(AT)的局部疾病患者的中位OS分别为21.2个月和28.8个月,分别为(P=0.007)。接受基于放疗的联合治疗(RCT)的局部晚期疾病患者的中位OS,新辅助治疗(NAT)后的手术,化疗时间为28.5个月,25.6个月,14.0个月,分别(P=0.002)。区域复发后的中位OS为16.0个月,13.4个月,在RCT中有8.9个月,化疗,和支持治疗小组,分别为(P=0.035)。多变量分析表明,糖类抗原19-9水平,病理分级,T-stage,N级,和切除是非转移性EOPC的独立预后因素。
结论:AT可改善局部患者的术后生存率。NAT和RCT后的手术是局部晚期EOPC患者的首选治疗选择。
BACKGROUND: The incidence of patients with early-onset pancreatic cancer (EOPC; age ≤ 50 years at diagnosis) is on the rise, placing a heavy burden on individuals, families, and society. The role of combination therapy including surgery, radiotherapy, and chemotherapy in non-metastatic EOPC is not well-defined.
OBJECTIVE: To investigate the treatment patterns and survival outcomes in patients with non-metastatic EOPC.
METHODS: A total of 277 patients with non-metastatic EOPC who were treated at our institution between 2017 and 2021 were investigated retrospectively. Overall survival (OS), disease-free survival, and progression-free survival were estimated using the Kaplan-Meier method. Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors.
RESULTS: With a median follow-up time of 34.6 months, the 1-year, 2-year, and 3-year OS rates for the entire cohort were 84.3%, 51.5%, and 27.6%, respectively. The median OS of patients with localized disease who received surgery alone and adjuvant therapy (AT) were 21.2 months and 28.8 months, respectively (P = 0.007). The median OS of patients with locally advanced disease who received radiotherapy-based combination therapy (RCT), surgery after neoadjuvant therapy (NAT), and chemotherapy were 28.5 months, 25.6 months, and 14.0 months, respectively (P = 0.002). The median OS after regional recurrence were 16.0 months, 13.4 months, and 8.9 months in the RCT, chemotherapy, and supportive therapy groups, respectively (P = 0.035). Multivariate analysis demonstrated that carbohydrate antigen 19-9 level, pathological grade, T-stage, N-stage, and resection were independent prognostic factors for non-metastatic EOPC.
CONCLUSIONS: AT improves postoperative survival in localized patients. Surgery after NAT and RCT are the preferred therapeutic options for patients with locally advanced EOPC.