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

Research Article

Tomoyuki Yokota¹  Yoshinori Ohno¹  Bunzo Matsuura²  Hirofumi Yamanishi²  Yoichi Hiasa²  Masanori Abe²  Teruki Miyake²  Morikazu Onji²  Shinya Furukawa²  Masashi Hirooka²  Mitsuhito Koizumi²  Nobuaki Azemoto²  Yoshiou Ikeda³  Teru Kumagi⁴  Taira Kuroda⁵  Yusuke Imai⁶  Haruka Tatsukawa⁶  Hiroki Utsunomiya⁶  Naozumi Shibata⁷  Yoshinori Tanaka⁸  Mari Nishiyama⁸  Hirotaka Seike⁹  Satoshi Imamine^1,10  Jiro Miyaike^1,11  Nobu Inada^1,12  Shin-ichi Okada^1,13 

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

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

DOI  :  10.1186/1471-230X-13-134

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

来源: Springer

【 摘 要 】

BackgroundAlthough 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.MethodsA 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.ResultsThe 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).ConclusionsLong-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】

Unknown   
© Kuroda et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.