背景:寻求胰腺导管腺癌(PDAC)的老年患者人数有所增加。我们旨在描述诊断为可切除PDAC的非年龄(90-99岁)患者的治疗选择的有效性。
方法:我们利用国家癌症数据库对2004-2021年非转移性PDAC(I-III期)患者进行鉴定。该研究使用Kaplan-Meier曲线比较了五个治疗类别的中位总生存期(mOS):手术,手术和放化疗,单纯化疗,单纯放疗,和单独的化学放射。Cox比例风险用于多变量分析。
结果:在459,174名患者中,793名年龄≥90岁患者患有非转移性PDAC。其中,245例(30.9%)患者单独接受化疗,296(37.3%)单纯放疗,162(20.4%)放化疗,58(7.3%)治愈性切除,32例(4.0%)接受了手术联合放化疗。不同治疗方式下单纯手术的mOS为9.5个月(95%CI6.7-14.5),19.1个月(95%CI2.4-64.3)用于手术联合放化疗,仅化疗8.2个月(95%CI7.2-9.2),仅放疗8.4个月(95%CI7.6-9.6),和11.2个月(95%CI8.7-12.9)(P<0.001)的放化疗。在多变量分析中,与单纯化疗患者相比,单纯手术患者的生存几率更高,尽管与接受单纯放疗或单纯放化疗的患者相比,它们没有显着差异。尽管如此,与单纯手术相比,手术联合放化疗与死亡率风险降低相关(HR:0.46[95%CI0.25-0.87],P=0.02)。手术30天死亡率为8.8%,90天死亡率为17.8%。
结论:与其他疗法相比,手术联合放化疗可改善患有PDAC的非未成熟患者的生存率。然而,25例患者中只有1例接受了所有3种治疗成分.其次,我们的研究强调了非年龄患者的手术死亡率非常高.
BACKGROUND: There has been an increase in the elderly patient population seeking care for pancreatic ductal adenocarcinoma (PDAC). This study aimed to delineate the effectiveness of therapeutic options in
nonagenarians (aged 90-99 years) diagnosed with resectable PDAC.
METHODS: This study used the National Cancer Database to identify patients with nonmetastatic PDAC (stage I-III) from 2004 to 2021. The study compared median overall survival (mOS) using Kaplan-Meier curves among 5 treatment categories: surgery, surgery along with chemoradiation, chemotherapy alone, radiotherapy alone, and chemoradiation alone. Cox proportional hazards regression was used in multivariate analyses.
RESULTS: Of 459,174 patients, 793 aged ≥ 90 years had nonmetastatic PDAC. Of 793 patients, 245 (30.9 %) underwent chemotherapy alone, 296 (37.3 %) underwent radiotherapy alone, 162 (20.4 %) underwent chemoradiation alone, 58 (7.3 %) underwent curative-intent resection, and 32 (4.0 %) underwent surgery combined with chemoradiation. The mOS estimates in different treatment modalities were 9.5 months (95 % CI, 6.7-14.5) for surgery alone, 19.1 months (95 % CI, 2.4-64.3) for surgery combined with chemoradiation, 8.2 months (95 % CI, 7.2-9.2) for chemotherapy alone, 8.4 months (95 % CI, 7.6-9.6) for radiotherapy alone, and 11.2 months (95 % CI, 8.7-12.9) for chemoradiation alone (P < .001). In multivariate analysis, the odds of survival were better for patients who underwent surgery alone than for those who underwent chemotherapy alone, although the odds of survival did not significantly differ between patients who underwent radiotherapy alone and those who underwent chemoradiation alone. Nonetheless, surgery combined with chemoradiation was associated with decreased mortality risk compared with surgery alone (hazard ratio, 0.46; 95 % CI, 0.25-0.87; P = .02). Operative 30-day mortality rate was 8.8 %, and 90-day mortality rate was 17.8 %.
CONCLUSIONS: Surgery combined with chemoradiation improved the survival of
nonagenarians with PDAC compared with other therapies. However, only 1 in 25 patients received all 3 treatment components. Moreover, our study highlights a very high operative mortality rate in
nonagenarians.