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进展期胰腺外分泌癌的化疗

Author
David P Ryan, MD
Section Editor
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD
Translators
杜奕奇, 主任医师，教授

引言

在美国，每年约有53,070例患者发生胰腺外分泌癌，由于该病的侵袭性特点，且患者就诊时多已处于疾病相对进展阶段，导致大部分患者死于该病[1]。这些肿瘤中大多数(85%)为起源于导管上皮的腺癌。 (参见“胰腺外分泌肿瘤的病理学”)

手术切除是治愈胰腺外分泌癌的唯一有效手段。然而，仅15%-20%的患者在初始诊断时为可切除肿瘤；大多数患者已有局部进展期或转移性癌。有局部进展期且无法切除病变的患者，中位生存期为8-12个月，而发生转移患者的中位生存期只有3-6个月。

本文将总结化疗在转移性胰腺癌治疗中的使用。而局部进展期胰腺癌患者的多学科治疗、缓解症状的具体方法，以及转移性胰岛细胞(内分泌)肿瘤患者的处理，将单独讨论。 (参见“Initial chemotherapy and radiation for nonmetastatic, locally advanced, unresectable and borderline resectable, exocrine pancreatic cancer”和“局部晚期或转移性胰腺外分泌癌患者的支持治疗”和“超声内镜引导下腹腔神经丛和神经节的介入治疗”和“分化良好的转移性胃肠胰神经内分泌肿瘤：表现、预后、成像及生化监测”)

治疗终点

由于胰腺癌原发灶处发生特征性的促结缔组织增生反应和炎症反应，用于确定对治疗的客观缓解的传统二维和一维肿瘤测量方法，通常不能充分评估胰腺癌的原发灶[2]。尽管如此，在胰腺癌的单药化疗试验中，通常仍使用客观缓解作为主要终点。与评估胰腺癌的原发肿瘤相比，这一终点在评估肝脏和其他部位的转移性病灶时可能更准确。

许多试验都允许纳入局部进展期的胰腺癌患者和胰腺癌发生转移的患者，这可能导致对治疗缓解率的低估。由于如此多的胰腺癌患者出现疼痛和抑郁，更近期的试验纳入了生存质量(quality of life, QOL)的终点[3-6]。此外，研究者日益强调将“临床获益”和生存期作为评价治疗有效性的更准确决定因素[7]。

                                            

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-13.
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