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Laurent-Badr Q, Barbe C, Brugel M, Hautefeuille V, Volet J, Grelet S, Desot E, Botsen D, Deguelte S, Pitta A, Abdelli N, Brasseur M, De Mestier L, Neuzillet C, Bouché O. Time intervals to diagnosis and chemotherapy do not influence survival outcome in patients with advanced pancreatic adenocarcinoma. Dig Liver Dis 2020; 52:658-667. [PMID: 32362489 DOI: 10.1016/j.dld.2020.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/23/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The effect of treatment delay on survival in pancreatic ductal adenocarcinoma (PDAC) remains unclear. AIMS This study aimed to assess the prognostic impact of time to diagnosis and chemotherapy in advanced PDAC and factors influencing the time intervals. METHODS advanced PDAC patients receiving chemotherapy in five centers in the decade 2007-2016 were included. Key time points during care pathway from clinical presentation to beginning of chemotherapy were retrospectively collected. Multivariate Cox proportional hazard model was performed. RESULTS A total of 409 patients were included (mean age 66.1 ± 10.3 years; 250 metastatic (61%); 139 received FOLFIRINOX chemotherapy (34%). The median overall survival (OS) was 7.2 months. The median times from first symptoms and from first specialist visit to the beginning of chemotherapy were respectively 100 days and 47 days. None of time intervals was significantly associated with OS. Significant prognostic factors were FOLFIRINOX chemotherapy (HR 0.6 [0.5-0.8]; P < 0.001), metastasis (HR 1.6 [1.3-2.0]; P = 0.001), WHO PS ≥ 2 (HR 1.6 [1.2-2.1]; P < 0.001) and acute pancreatitis as first symptom (HR 2.9 [1.7-4.9]; P < 0.001). Jaundice shortened time to diagnosis (P < 0.001). Acute pancreatitis (P < 0.001) and diabetes (P = 0.01) increased time to treatment. CONCLUSION Wait times from clinical presentation to beginning of chemotherapy do not influence survival in advanced PDAC.
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Affiliation(s)
- Q Laurent-Badr
- Digestive Oncology, Reims University Hospital, Reims, France.
| | - C Barbe
- Research and Public Health, Reims University Hospital, Reims, France
| | - M Brugel
- Digestive Oncology, Reims University Hospital, Reims, France
| | - V Hautefeuille
- Gastroenterology, Amiens-Picardie University Hospital, France
| | - J Volet
- Gastroenterology, Courlancy-Bezannes Clinic, Bezannes, France
| | - S Grelet
- Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
| | - E Desot
- Medical Oncology, Institut de Cancérologie Godinot, Reims, France
| | - D Botsen
- Digestive Oncology, Reims University Hospital, Reims, France; Medical Oncology, Institut de Cancérologie Godinot, Reims, France
| | - S Deguelte
- General, Digestive and Endocrine Surgery, Reims University Hospital, Reims, France
| | - A Pitta
- Digestive Oncology, Reims University Hospital, Reims, France
| | - N Abdelli
- Gastroenterology, Châlons-en-Champagne Hospital, Châlons-en-Champagne, France
| | - M Brasseur
- Digestive Oncology, Reims University Hospital, Reims, France
| | - L De Mestier
- Gastroenterology and Pancreatology, Beaujon University Hospital, APHP, Clichy, France
| | - C Neuzillet
- Medical Oncology, Curie Institute, Versailles Saint Quentin University, Saint-Cloud, France
| | - O Bouché
- Digestive Oncology, Reims University Hospital, Reims, France
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de Mestier L, Neuzillet C, Pozet A, Desot E, Deguelte-Lardière S, Volet J, Karoui M, Kianmanesh R, Bonnetain F, Bouché O. Is primary tumor resection associated with a longer survival in colon cancer and unresectable synchronous metastases? A 4-year multicentre experience. Eur J Surg Oncol 2014; 40:685-91. [PMID: 24630774 DOI: 10.1016/j.ejso.2014.02.236] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the survival impact of primary tumor resection (PTR) in patients with metastatic colon cancer (mCC) and unresectable metastases. METHODS We retrospectively studied a multicenter cohort of consecutive mCC patients with unresectable metastases receiving first-line chemotherapy. A weighted Cox proportional regression model was used to balance for clinical variables associated with the probability of undergoing PTR, using inverse probability of treatment weighting (IPTW) based on a propensity score. RESULTS Ninety-six patients were included. PTR was performed in 69 (72%). The rates of secondary resection of metastases (p = 0.02) and bevacizumab administration (p = 0.02) were higher in the PTR group. Raw median overall survival (OS) was 23.1 months (95%CI[14.6-27.8]) in the PTR group and 22.1 months (95%CI[12.3-23.7]) in the non-PTR group (p = 0.11). After adjustment on IPTW, OS was 23.1 months (95%CI[17.0-28.7]) in the PTR group and 17.2 months (95%CI[13.5-22.2]) in the non-PTR group (HR 0.68; 95%CI[0.50-0.93]; p = 0.016). This result remained significant on multivariate analysis (HR 0.71; 95%CI[0.50-1.00]; p = 0.05). CONCLUSION In mCC patients with unresectable metastases receiving chemotherapy, up-front PTR was independently associated with prolonged OS. Patients eligible for secondary metastases resection and/or bevacizumab may benefit the most from PTR. Randomized controlled trials are mandatory.
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Affiliation(s)
- L de Mestier
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France.
| | - C Neuzillet
- Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Clichy, France
| | - A Pozet
- Unit of Methodology and Quality of Life in Oncology, EA 3181, Saint-Jacques University Hospital, Besançon, France
| | - E Desot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France
| | - S Deguelte-Lardière
- Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France
| | - J Volet
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France
| | - M Karoui
- Department of Digestive Surgery, Pitié-Salpetrière University Hospital, Assistance Publique Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
| | - R Kianmanesh
- Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France
| | - F Bonnetain
- Unit of Methodology and Quality of Life in Oncology, EA 3181, Saint-Jacques University Hospital, Besançon, France
| | - O Bouché
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France.
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