Analysis of Recent Improvement of Survival Outcomes in Patients with Pancreatic Cancer Who Underwent Upfront Surgery
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Recently, patients with pancreatic cancer (PC) who underwent resection have exhibited improved survival outcomes, but comprehensive analysis is limited. We analyzed the trends of contributing factors. Methods: Data of patients with resected PC were retrospectively collected from the Korean Health Insurance Review and Assessment Service (HIRA) database and separately at our institution. Cox regression analysis was conducted with the data from our institution a survival prediction score was calculated using the β coefficients. Results: Comparison between the periods 2013–2015 (n=3,255) and 2016–2018 (n=3,698) revealed a difference in the median overall survival (25.9 months vs not reached, p<0.001) when analyzed with the HIRA database which was similar to our single-center data (2013–2015 [n=119] vs 2016–2018 [n=148], 20.9 months vs 32.2 months, p=0.003). Multivariable analyses revealed six factors significantly associated with better OS, and the scores were as follows: age >70 years, 1; elevated carbohydrate antigen 19-9 at diagnosis, 1; R1 resection, 1; stage N1 and N2, 1 and 3, respectively; no adjuvant treatment, 2; FOLFIRINOX or gemcitabine plus nab-paclitaxel after recurrence, 4; and other chemotherapy or supportive care only after recurrence, 5. The rate of R0 resection (69.7% vs 80.4%), use of adjuvant treatment (63.0% vs 74.3%), and utilization of FOLFIRINOX or gemcitabine plus nab-paclitaxel (25.2% vs 47.3%) as palliative chemotherapeutic regimen, all increased between the two time periods, resulting in decreased total survival prediction score (mean: 7.32 vs 6.18, p=0.004). Conclusions: Strict selection of surgical candidates, more use of adjuvant treatment, and adoption of the latest combination regimens for palliative chemotherapy after recurrence were identified as factors of recent improvement.
Abstract
Background/Aims: Recently, patients with pancreatic cancer (PC) who underwent resection have exhibited improved survival outcomes, but comprehensive analysis is limited. We analyzed the trends of contributing factors. Methods: Data of patients with resected PC were retrospectively collected from the Korean Health Insurance Review and Assessment Service (HIRA) database and separately at our institution. Cox regression analysis was conducted with the data from our institution a survival prediction score was calculated using the β coefficients. Results: Comparison between the periods 2013–2015 (n=3,255) and 2016–2018 (n=3,698) revealed a difference in the median overall survival (25.9 months vs not reached, p<0.001) when analyzed with the HIRA database which was similar to our single-center data (2013–2015 [n=119] vs 2016–2018 [n=148], 20.9 months vs 32.2 months, p=0.003). Multivariable analyses revealed six factors significantly associated with better OS, and the scores were as follows: age >70 years, 1; elevated carbohydrate antigen 19-9 at diagnosis, 1; R1 resection, 1; stage N1 and N2, 1 and 3, respectively; no adjuvant treatment, 2; FOLFIRINOX or gemcitabine plus nab-paclitaxel after recurrence, 4; and other chemotherapy or supportive care only after recurrence, 5. The rate of R0 resection (69.7% vs 80.4%), use of adjuvant treatment (63.0% vs 74.3%), and utilization of FOLFIRINOX or gemcitabine plus nab-paclitaxel (25.2% vs 47.3%) as palliative chemotherapeutic regimen, all increased between the two time periods, resulting in decreased total survival prediction score (mean: 7.32 vs 6.18, p=0.004). Conclusions: Strict selection of surgical candidates, more use of adjuvant treatment, and adoption of the latest combination regimens for palliative chemotherapy after recurrence were identified as factors of recent improvement.
참고문헌 (32)
- Siegel RL, "Cancer statistics, 2022", CA Cancer J Clin, 72, pp.7~33 (2022)
- Park W, "Pancreatic cancer : a review", JAMA, 326, pp.851~862 (2021)
- Aaltonen P, "Long-term nationwide trends in the treatment of and outcomes among pancreatic cancer patients", Eur J Surg Oncol, 48, pp.1087~1092 (2022)
- Blackford AL, "Recent trends in the incidence and survival of stage 1A pancreatic cancer : a surveillance, epidemiology, and end results analysis", J Natl Cancer Inst, 112, pp.1162~1169 (2020)
- Strobel O, "Optimizing the outcomes of pancreatic cancer surgery", Nat Rev Clin Oncol, 16, pp.11~26 (2019)
- Murphy JE, "Total neoadjuvant therapy with FOLFIRINOX followed by individualized chemoradiotherapy for borderline resectable pancreatic adenocarcinoma : a phase 2 clinical trial", JAMA Oncol, 4, pp.963~969 (2018)
- Versteijne E, "neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer : long-term results of the Dutch randomized PREOPANC trial", J Clin Oncol, 40, pp.1220~1230 (2022)
- Chaudhari VA, "Neoadjuvant therapy in borderline resectable pancreatic cancer : outcomes in the era of changing practices and evolving evidence", Surgery, 171, pp.1388~1395 (2022)
- Zhang G, "Systemic therapy and perioperative management improve the prognosis of pancreatic ductal adenocarcinoma : a retrospective cohort study of 2000 consecutive cases", Int J Surg, 104, pp.106786~ (2022)
- Conroy T, "Five-year outcomes of FOLFIRINOX vs gemcitabine as adjuvant therapy for pancreatic cancer : a randomized clinical trial", JAMA Oncol, 8, pp.1571~1578 (2022)
- Conroy T, "FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer", N Engl J Med, 379, pp.2395~2406 (2018)
- Neoptolemos JP, "Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer(ESPAC-4) : a multicentre, open-label, randomised, phase 3trial", Lancet, 389, pp.1011~1024 (2017)
- Conroy T, "FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer", N Engl J Med, 364, pp.1817~1825 (2011)
- Von Hoff DD, "Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine", N Engl J Med, 369, pp.1691~1703 (2013)
- Finks JF, "Trends in hospital volume and operative mortality for high-risk surgery", N Engl J Med, 364, pp.2128~2137 (2011)
- Latenstein AEJ, "Effect of centralization and regionalization of pancreatic surgery on resection rates and survival", Br J Surg, 108, pp.826~833 (2021)
- van Roessel S, "International validation of the eighth edition of the American Joint Committee on Cancer(AJCC)TNM staging system in patients with resected pancreatic cancer", JAMA Surg, 153, pp.e183617~ (2018)
- Sullivan LM, "Presentation of multivariate data for clinical use : The Framingham Study risk score functions", Stat Med, 23, pp.1631~1660 (2004)
- Alonzo TA, "Clinical prediction models : a practical approach to development, validation, and updating : by Ewout W. Steyerberg", Am J Epidemiol, 170, pp.528~ (2009)
- Wolbers M, "Prognostic models with competing risks : methods and application to coronary risk prediction", Epidemiology, 20, pp.555~561 (2009)
- "NCCN Guidelines Version 2.2023 Pancreatic Adenocarcinoma" (2023)[URL]
- Versteijne E, "Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer : results of the Dutch randomized phase III PREOPANC trial", J Clin Oncol, 38, pp.1763~1773 (2020)
- Machairas N, "the impact of neoadjuvant treatment on survival in patients undergoing pancreatoduodenectomy with concomitant portomesenteric venous resection : an international multicenter analysis", Ann Surg, 274, pp.721~728 (2021)
- Coppola A, "Role of CA 19. 9 in the management of resectable pancreatic cancer : state of the art and future perspectives", Biomedicines, 10, pp.2091~ (2022)
- Saka B, "Pancreatic ductal adenocarcinoma is spread to the peripancreatic soft tissue in the majority of resected cases, rendering the AJCC T-stage protocol(7th edition)inapplicable and insignificant : a size-based staging system(pt1 : ≤2, pt2 : >2-≤4, pt3 : >4 cm)is more valid and clinically relevant", Ann Surg Oncol, 23, pp.2010~2018 (2016)
- Watanabe G, "Impact of tumor size on the outcomes of patients with resectable distal pancreatic cancer : lessons learned from a series of 158 radical resections", Ann Surg Oncol, 29, pp.378~388 (2022)
- Neoptolemos JP, "A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer", N Engl J Med, 350, pp.1200~1210 (2004)
- Latenstein AEJ, "Nationwide trends in incidence, treatment and survival of pancreatic ductal adenocarcinoma", Eur J Cancer, 125, pp.83~93 (2020)
- Tempero MA, "Adjuvant nabpaclitaxel + gemcitabine in resected pancreatic ductal adenocarcinoma : results from a randomized, open-label, phase iii trial", J Clin Oncol, 41, pp.2007~2019 (2023)
- Oettle H, "Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer : the CONKO-001randomized trial", JAMA, 310, pp.1473~1481 (2013)
- Hank T, "A pretreatment prognostic score to stratify survival in pancreatic cancer", Ann Surg, 276, pp.e914~e922 (2022)
- Habib JR, "Surgical decision-making in pancreatic ductal adenocarcinoma : modeling prognosis following pancreatectomy in the era of induction and neoadjuvant chemotherapy", Ann Surg, 277, pp.151~158 (2023)