Improvement of long-term outcomes in pancreatic cancer and its associated factors within the gemcitabine era: a collaborative retrospective multicenter clinical review of 1,082 patients
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- 作者：Taira Kuroda (1)
Teru Kumagi (1) (2)
Tomoyuki Yokota (3)
Hirotaka Seike (4)
Mari Nishiyama (5)
Yusuke Imai (6)
Nobu Inada (7)
Naozumi Shibata (8)
Satoshi Imamine (9)
Shin-ichi Okada (10)
Mitsuhito Koizumi (1)
Hirofumi Yamanishi (1)
Nobuaki Azemoto (1)
Jiro Miyaike (2)
Yoshinori Tanaka (5)
Haruka Tatsukawa (6)
Hiroki Utsunomiya (6)
Yoshinori Ohno (3)
Teruki Miyake (1)
Masashi Hirooka (1)
Shinya Furukawa (1)
Masanori Abe (1)
Yoshiou Ikeda (1) (11)
Bunzo Matsuura (1)
Yoichi Hiasa (1)
Morikazu Onji (1) - 关键词：Pancreatic cancer ; Chemotherapy ; Best supportive care ; Gemcitabine ; Long ; term outcome ; Japan
- 刊名：BMC Gastroenterology
- 出版年：2013
- 出版时间：December 2013
- 年：2013
- 卷：13
- 期：1
- 全文大小：1206KB
- 参考文献：1. Raimondi S, Maisonneuve P, Lowenfels AB: Epidemiology of pancreatic cancer: an overview. / Nat Rev Gastroenterol Hepatol 2009, 6:699-08. CrossRef
2. Kelsen DP, Portenoy R, Thaler H, Tao Y, Brennan M: Pain as a predictor of outcome in patients with operable pancreatic carcinoma. / Surgery 1997, 122:53-9. CrossRef
3. Tanaka M: Japan Pancreas Society. Pancreatic Cancer Registry Report 2007 (in Japanese with English Abstract). / Suizou 2007, 22:e1-e94. CrossRef
4. Egawa S, Toma H, Ohigashi H, Okusaka T, Nakao A, Hatori T, Maguchi H, Yanagisawa A, Tanaka M: Japan Pancreatic Cancer Registry; 30th Year Anniversary. Japan Pancreas Society. / Pancreas 2012, 41:985-92. CrossRef
5. Isaji S, Kawarada Y: Evaluation of classification of pancreatic cancer by the Japan Pancreas Society and Union Internationale Contre le Cancer and proposal for a new international classification (in Japanese with English Abstract). / Nihon Geka Gakkai Zasshi 2000, 101:205-11.
6. Doi R, Imamura M, Hosotani R, Imaizumi T, Hatori T, Takasaki K, Funakoshi A, Wakasugi H, Asano T, Hishinuma S, Ogata Y, Sunamura M, Yamaguchi K, Tanaka M, Takao S, Aikou T, Hirata K, Maguchi H, Aiura K, Aoki T, Kakita A, Sasaki M, Ozaki M, Matsusue S, Higashide S, Noda H, Ikeda S, Maetani S, Yoshida S: Japan Pancreatic Cancer Study Group. Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: final results of a randomized multi-institutional trial. / Surg Today 2008, 38:1021-028. CrossRef
7. Imamura M, Doi R, Imaizumi T, Funakoshi A, Wakasugi H, Sunamura M, Ogata Y, Hishinuma S, Asano T, Aikou T, Hosotani R, Maetani S: A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer. / Surgery 2004, 136:1003-011. CrossRef
8. Hatori T, Imaizumi T, Nakasako T, Harada N, Suzuki T, Tenma N, Hanyu F, Takasaki K: A study for limit of the extended radical operation for ductal adenocarcinoma of the head of the pancreas in aged patients (in Japanese with English abstract). / Jpn J Gastroenterol Surg 1996, 29:2043-047. CrossRef
9. Yamagishi Y, Higuchi H, Izumiya M, Sakai G, Iizuka H, Nakamura S, Adachi M, Hozawa S, Takaishi H, Hibi T: Gemcitabine as first-line chemotherapy in elderly patients with unresectable pancreatic carcinoma. / J Gastroenterol 2010, 45:1146-154. CrossRef
10. Dale DC: Poor prognosis in elderly patients with cancer: the role of bias and undertreatment. / J Support Oncol 2003, 1:11-7.
11. Langer CJ: Elderly patients with lung cancer: biases and evidence. / Curr Treat Options Oncol 2002, 3:85-02. CrossRef
12. Guadagnoli E, Shapiro C, Gurwitz JH, Silliman RA, Weeks JC, Borbas C, Soumerai SB: Age-related patterns of care: evidence against ageism in the treatment of early-stage breast cancer. / J Clin Oncol 1997, 15:2338-344.
13. Szafranska AE, Doleshal M, Edmunds HS, Gordon S, Luttges J, Munding JB, Barth RJ Jr, Gutmann EJ, Suriawinata AA, Marc Pipas J, Tannapfel A, Korc M, Hahn SA, Labourier E, Tsongalis GJ: Analysis of microRNAs in pancreatic fine-needle aspirates can classify benign and malignant tissues. / Clin Chem 2008, 54:1716-724. CrossRef
14. Li A, Omura N, Hong SM, Vincent A, Walter K, Griffith M, Borges M, Goggins M: Pancreatic cancers epigenetically silence SIP1 and hypomethylate and overexpress miR-200a/200b in association with elevated circulating miR-200a and miR-200b levels. / Cancer Res 2010, 70:5226-237. CrossRef
15. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-230X/13/134/prepub - 作者单位：Taira Kuroda (1)
Teru Kumagi (1) (2)
Tomoyuki Yokota (3)
Hirotaka Seike (4)
Mari Nishiyama (5)
Yusuke Imai (6)
Nobu Inada (7)
Naozumi Shibata (8)
Satoshi Imamine (9)
Shin-ichi Okada (10)
Mitsuhito Koizumi (1)
Hirofumi Yamanishi (1)
Nobuaki Azemoto (1)
Jiro Miyaike (2)
Yoshinori Tanaka (5)
Haruka Tatsukawa (6)
Hiroki Utsunomiya (6)
Yoshinori Ohno (3)
Teruki Miyake (1)
Masashi Hirooka (1)
Shinya Furukawa (1)
Masanori Abe (1)
Yoshiou Ikeda (1) (11)
Bunzo Matsuura (1)
Yoichi Hiasa (1)
Morikazu Onji (1)
1. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, To-on, Ehime, 791-0295, Japan
2. Internal Medicine, Saiseikai Imabari Hospital, Imabari, Ehime, 799-1592, Japan
3. Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Ehime, 790-8524, Japan
4. Gastroenterology, Uwajima Municipal Hospital, Uwajima, Ehime, 798-8510, Japan
5. Gastroenterology, Matsuyama Municipal Hospital, Matsuyama, Ehime, 790-0067, Japan
6. Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, 790-0024, Japan
7. Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, 791-8026, Japan
8. Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama, Ehime, 792-0042, Japan
9. Internal Medicine, Ohzu Municipal Hospital, Ohzu, Ehime, 795-0013, Japan
10. Internal Medicine, Saiseikai Saijo Hospital, Saijo, Ehime, 793-0027, Japan
11. Endoscopy Center, Ehime University Hospital, Ehime, Ehime, 791-0295, Japan
文摘
Background Although the outcomes of pancreatic cancer have been improved by gemcitabine, the changes in its characteristics and long-term outcomes within the gemcitabine era remain unclear. This study was conducted to identify clinical characteristics of pancreatic cancer patients within the gemcitabine era. Methods A retrospective chart review was performed at 10 centers for 1,248 consecutive patients who were ever considered to have a diagnosis of pancreatic cancer between 2001 and 2010. Data collected included demographics, diagnosis date, clinical stage, treatment, and outcome; 1,082 patients met the inclusion criteria and were analyzed further. The chi-square test, Student’s t-test, and Mann–Whitney U-test were used for statistical analysis. Outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Differences in survival analyses were determined using the log-rank test. Results The distribution of clinical stages was: I, 2.2%; II, 3.4%; III, 13%; IVa, 27%; and IVb, 55%. Chemotherapy alone was administered to 42% of patients and 17% underwent resection. The 1-, 3-, and 5-year survival rates were 39%, 13%, and 6.9%, respectively. The median survival time was 257?days, but differed considerably among treatments and clinical stages. Demographics, distribution of clinical stage, and cause of death did not differ between groups A (2001-005, n--06) and B (2006-010, n--76). However, group B included more patients who underwent chemotherapy (P-lt;-.0001) and fewer treated with best supportive care (P--.0004), mirroring improvements in this group’s long-term outcomes (P--.0063). Finally, factors associated with long-term outcomes derived from multivariate analysis were clinical stage (P-lt;-.0001), location of the tumor (P--.0294) and treatments (surgery, chemotherapy) (P-lt;-.0001). Conclusions Long-term outcomes in pancreatic cancer has improved even within the gemcitabine era, suggesting the importance of offering chemotherapy to patients previously only considered for best supportive care. Most patients are still diagnosed at an advanced stage, making clinical strategy development for diagnosing pancreatic cancer at earlier stages essential.