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

BMC Gastroenterology

Morikazu Onji⁸  Yoichi Hiasa⁸  Bunzo Matsuura⁸  Yoshiou Ikeda^1,10  Masanori Abe⁸  Shinya Furukawa⁸  Masashi Hirooka⁸  Teruki Miyake⁸  Yoshinori Ohno⁹  Hiroki Utsunomiya⁵  Haruka Tatsukawa⁵  Yoshinori Tanaka^1,11  Jiro Miyaike³  Nobuaki Azemoto⁸  Hirofumi Yamanishi⁸  Mitsuhito Koizumi⁸  Shin-ichi Okada¹  Satoshi Imamine²  Naozumi Shibata⁶  Nobu Inada⁴  Yusuke Imai⁵  Mari Nishiyama^1,11  Hirotaka Seike⁷  Tomoyuki Yokota⁹  Teru Kumagi³  Taira Kuroda⁸ 

[1] Internal Medicine, Saiseikai Saijo Hospital, Saijo, Ehime 793-0027, Japan;Internal Medicine, Ohzu Municipal Hospital, Ohzu, Ehime 795-0013, Japan;Internal Medicine, Saiseikai Imabari Hospital, Imabari, Ehime 799-1592, Japan;Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime 791-8026, Japan;Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime 790-0024, Japan;Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama, Ehime 792-0042, Japan;Gastroenterology, Uwajima Municipal Hospital, Uwajima, Ehime 798-8510, Japan;Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, To-on, Ehime 791-0295, Japan;Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Ehime 790-8524, Japan;Endoscopy Center, Ehime University Hospital, Ehime, Ehime 791-0295, Japan;Gastroenterology, Matsuyama Municipal Hospital, Matsuyama, Ehime 790-0067, Japan

关键词: Japan;    Long-term outcome;    Gemcitabine;    Best supportive care;    Chemotherapy;    Pancreatic cancer;   

Others  :  857637
DOI  :  10.1186/1471-230X-13-134

 received in 2013-02-05, accepted in 2013-08-27,  发布年份 2013

【 摘 要 】

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 (2001–2005, n = 406) and B (2006–2010, n = 676). However, group B included more patients who underwent chemotherapy (P < 0.0001) and fewer treated with best supportive care (P = 0.0004), mirroring improvements in this group’s long-term outcomes (P = 0.0063). Finally, factors associated with long-term outcomes derived from multivariate analysis were clinical stage (P < 0.0001), location of the tumor (P = 0.0294) and treatments (surgery, chemotherapy) (P < 0.0001).

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.

【 授权许可】

   
2013 Kuroda et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Raimondi S, Maisonneuve P, Lowenfels AB: Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol 2009, 6:699-708.
• [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, 122:53-59.
• [3]Tanaka M: Japan Pancreas Society. Pancreatic Cancer Registry Report 2007 (in Japanese with English Abstract). Suizou 2007, 22:e1-e94.
• [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, 41:985-992.
• [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, 101:205-211.
• [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, 38:1021-1028.
• [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, 136:1003-1011.
• [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, 29:2043-2047.
• [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, 45:1146-1154.
• [10]Dale DC: Poor prognosis in elderly patients with cancer: the role of bias and undertreatment. J Support Oncol 2003, 1:11-17.
• [11]Langer CJ: Elderly patients with lung cancer: biases and evidence. Curr Treat Options Oncol 2002, 3:85-102.
• [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, 15:2338-2344.
• [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, 54:1716-1724.
• [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, 70:5226-5237.