放化疗联合靶向免疫治疗复发转移性胰腺癌患者的预后分析

吴陈陈; 曹必样; 张乐天; 王竞

doi:10.12435/j.issn.2095-5227.2023.013

放化疗联合靶向免疫治疗复发转移性胰腺癌患者的预后分析

Prognosis analysis of patients with recurrent metastatic pancreatic cancer treated with radiotherapy and chemotherapy combined with targeted and or immunotherapy

摘要

摘要:
背景早期胰腺癌可通过手术切除，辅以化疗、放疗等治疗方法，术后5年生存率约20%。局部-区域复发及远处转移是导致胰腺癌治疗失败的主要原因。目前关于复发转移性胰腺癌的治疗方案选择有限，且国内外相关文献报道较少。
目的探索胰腺癌根治术后复发转移患者接受放化疗联合靶向及免疫治疗的预后及其影响因素。
方法收集2011年1月 - 2021年9月在解放军总医院接受胰腺癌根治术后出现复发转移，而后行放疗、化疗、靶向和(或)免疫治疗等综合治疗的胰腺癌患者临床资料，分析预后因素及治疗失败模式。
结果 41例接受综合治疗的患者纳入研究，男33例，女8例，中位年龄56岁。中位随访时间为75 (范围：31.5 ~ 118.5)个月，根治术后中位总生存期(median overall survival，mOS)为26.3个月，1年、2年、3年、5年的OS率为90.2%、63.4%、36.6%、19.5%；根治术后中位无病生存期(median disease free survival，mDFS)为9.8个月，1年、2年、3年、5年的DFS率为75.6%、19.5%、2.4%、2.4%。复发转移后的mOS为17.1个月，1年、2年、3年、5年的OS率为65.8%、44.0%、26.8%、4.8%。多因素Cox回归分析显示，对于根治术后总生存，男性(HR=6.98， P=0.011)患者预后更差，化疗周期数≥10 (HR=0.08，P=0.009)者预后较好；对于复发转移后总生存，男性(HR=3.85，P=0.024)、病理类型低分化者(HR=2.42，P=0.039)预后更差，术后化疗周期数≥10 (HR=0.16，P＜0.001)者预后更好。肝转移(31.7%，13/41)和局部复发(46.3%，19/41) 是根治术后主要的治疗失败模式。
结论放化疗联合靶向及免疫治疗在胰腺癌根治术后复发转移患者中具有较好的生存受益和耐受性，可作为复发转移患者的治疗选择。

Abstract:
Background Early stage pancreatic cancer can be treated by surgical resection, supplemented by chemotherapy and radiotherapy, with a 5-year survival rate of about 20% after surgery. However, local-regional recurrence and distant metastasis are the main causes of treatment failure for pancreatic cancer. The current treatment options for recurrent metastatic pancreatic cancer are limited and poorly reported in the domestic and international literature.
Objective To explore the prognosis of patients with recurrent metastases after radical pancreatic cancer surgery receiving radiotherapy and chemotherapy combined with targeted and/or immunotherapy and its influencing factors.
Methods From January 2011 to September 2021, clinical data were collected from pancreatic cancer patients who developed recurrent metastasis after radical pancreatic cancer surgery in Chinese PLA General Hospital and were subsequently treated with a combination of radiotherapy, chemotherapy, targeted and/or immunotherapy, and the prognostic factors and treatment failure patterns were analyzed.
Results There were 41 cases wer selected, including 33 males and 8 females, with a median age of 56 years-old. The median follow-up was 75 months (31.5 to 118.5), with a median overall survival (mOS) of 26.3 months and OS of 90.2%, 63.4%, 36.6%, and 19.5% at 1, 2, 3, and 5 years; the median disease free survival (mDFS) after radical pancreatic cancer surgery was 9.8 months, and the DFS rates at 1, 2, 3, and 5 years were 75.6%, 19.5%, 2.4%, and 2.4%; the mOS for patients with recurrent metastases after radical surgery who received radiotherapy and chemotherapy combined with targeted and or immunotherapy was 17.1 months, and the OS at 1, 2, 3, and 5 years was 65.8%, 44.0%, 26.8% and 4.8%. Multifactorial Cox regression analysis showed that male (HR=3.85, P=0.024), poor differentiation (HR=2.42, P=0.039), and the number of chemotherapy cycles ≥10 after radical surgery (HR=0.16, P<0.001) were independently associated with overall survival after recurrence or metastasis. Male (HR=6.98, P=0.011) and the number of chemotherapy cycles after recurrent metastasis ≥10 (HR=0.08, P=0.009) were independently associated with the overall survival after radical resection. Liver metastasis (31.7%, 13/41) and local recurrence (46.3%, 19/41) were the main patterns of treatment failure after radical surgery.
Conclusion Radiotherapy and chemotherapy combined with targeted and or immunotherapy has good survival benefits and tolerance, which can be used as a treatment choice for patients with recurrent and metastatic pancreatic cancer after radical resection.

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