对于无法切除的胆道癌症的老年患者进行组合化疗:使用倾向性评分匹配分析的前性观察研究 (JON2104-B)
Satoshi Kobayashi1, Kohei Nakachi2, Kouji Yamamoto3
1Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, 241-0815, Japan. kobayashi.0v70a@kanagawa-pho.jp.
Journal of gastroenterology
|September 6, 2025
概括
在健康的老年患有晚期胆道癌症 (aBTC) 患者中,吉姆西塔加西斯加S-1 (GEM+CDDP+S-1) 改善了无进展的生存期,但毒性没有增加. 在易受伤害的患者中,疗效没有显著差异.
科学领域:
- 癌症学
- 胃肠病学
- 临床药理学
背景情况:
- 晚期胆道癌症 (aBTC) 的标准化疗包括gemcitabine加S-1 (GEM+S-1),GEM+CDDP+S-1或GEM+CDDP.
- 老年患者 (≥70岁) 占有大量BTC患者,需要量身定制的治疗评估.
- 评估不同化疗方案的疗效和安全性对于优化患者的治疗结果至关重要.
研究的目的:
- 在晚期胆道癌症 (aBTC) 的老年患者中评估组合化疗方案的疗效和安全性.
- 为了比较不同化疗组合的整体存活率 (OS) 和无进展存活率 (PFS).
- 研究患者脆弱性对该群体治疗结果的影响.
主要方法:
- 一项多中心前性观察研究 (JON2104- B) 涉及305名年龄≥70岁的aBTC患者.
- 治疗组包括GEM+CDDP+S-1,GEM+CDDP,GEM+S-1,gemcitabine和S-1.
- 使用逆概率加权倾向分数分析 (IPW) 来比较OS和PFS,并根据基线特征进行调整.
主要成果:
- 与健康的老年患者相比,GEM+CDDP+S-1显示了改善OS (HR 0.80) 和显著改善PFS (HR 0.55) 的趋势.
- 虽然GEM+CDDP的安全性与GEM+CDDP+S-1相似,但其毒性却高于单一药物gemcitabine.
- 在易受伤害的老年患者中,GEM+CDDP和gemcitabine之间没有观察到显著的生存或PFS差异.
结论:
- 与GEM+CDDP相比,GEM+CDDP+S-1在适应BTC的老年患者的PFS中提供了潜在的好处.
- 在GEM+CDDP+S-1和GEM+CDDP之间,整体存活率没有显著差异.
- 患者的脆弱性是影响aBTC老年患者治疗疗效的关键因素,强调需要个性化治疗策略.
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