Clinical role of intraperitoneal chemotherapy in patients with pancreatic ductal adenocarcinoma concomitant with occult peritoneal dissemination: A multicenter retrospective study

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2025-03-04 DOI:10.1002/ags3.70001

Tomohisa Yamamoto, Toshio Shimokawa, Masamichi Hayashi, Masamichi Mizuma, Katsuhisa Hirano, Atsushi Oba, Toshimichi Asano, Hideyo Miyato, Makoto Yoshida, Ippei Matsumoto, Yasunari Kawabata, Katsunori Sakamoto, Fuyuhiko Motoi, Shigeto Ishii, Yuki Homma, Hiromitsu Maehira, Yutaro Matsunaga, Tetsuya Ikemoto, Masafumi Nakamura, Yuko Mataki, Tsuyoshi Notake, Keiichi Akahoshi, Hideki Takami, So Yamaki, Daisuke Hashimoto, Yasutoshi Kimura, Satoshi Hirano, Yosuke Inoue, Tsutomu Fujii, Michiaki Unno, Yasuhiro Kodera, Joji Kitayama, Sohei Satoi, the Study Group of Pancreatic Ductal Adenocarcinoma with Peritoneal Dissemination

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Abstract

Background

The effectiveness of intraperitoneal chemotherapy using paclitaxel (i.p.-PTX) in pancreatic ductal adenocarcinoma (PDAC) patients with peritoneal dissemination remains elusive. The aim of this study is to investigate the clinical outcome of patients treated with i.p.-PTX combined with systemic chemotherapy compared with current standard chemotherapy including gemcitabine plus nab-paclitaxel and FOLFIRINOX.

Methods

Data of patients with peritoneal dissemination was retrospectively collected and analyzed (i.p.-PTX, n = 83; control, n = 86). Inverse probability of treatment-weighted analyses (IPTW) was used to balance baseline characteristics between two groups. Survival curves were estimated using Kaplan–Meier method, and the differences were compared using the log-rank test.

Results

No significant differences were noted in overall survival (14.9 vs. 15.5 months, p = 0.481) and progression free survival (9.5 vs. 9.1 months, p = 0.267) between i.p.-PTX and the control groups. Nevertheless, i.p.-PTX (9.9 months) significantly prolonged the median progression-free survival (PFS) time compared with the control (8.6 months), among the matched patients using IPTW (hazard ratio 0.666, p = 0.041). Moreover, subgroup analysis among the patients whose primary tumor were evaluated either as resectable or borderline resectable disease revealed significantly better overall survival in the i.p.-PTX group compared with the control group (21.3 vs. 14.7 months, hazard ratio; 0.532, p = 0.033). Conversion surgery was more frequently performed in the i.p.-PTX group than the control group (24% vs. 4%, p = 0.006).

Conclusion

The i.p. PTX regimen prolonged PFS but not overall survival, and subgroup analysis suggested the possibility of survival benefit in patients with occult peritoneal dissemination whose primary tumor was classified as resectable/borderline resectable disease.

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腹腔内化疗在胰管腺癌伴隐蔽性腹膜播散患者中的临床作用：一项多中心回顾性研究

背景紫杉醇腹腔化疗（ipp - ptx）治疗伴有腹膜播散的胰管腺癌（PDAC）的疗效尚不明确。本研究的目的是比较ipp - ptx联合全身化疗与目前标准化疗（吉西他滨+ nab-紫杉醇和FOLFIRINOX）的临床疗效。方法回顾性收集腹膜播散患者资料(ipp - ptx, n = 83；对照组，n = 86)。使用治疗加权逆概率分析（IPTW）来平衡两组之间的基线特征。生存曲线估计采用Kaplan-Meier法，差异比较采用log-rank检验。结果ipp - ptx组与对照组的总生存期（14.9个月vs 15.5个月，p = 0.481）和无进展生存期（9.5个月vs 9.1个月，p = 0.267）无显著差异。然而，在使用IPTW的匹配患者中，ipp - ptx（9.9个月）与对照组（8.6个月）相比，显著延长了中位无进展生存期（PFS）时间（风险比0.666,p = 0.041）。此外，对原发肿瘤被评估为可切除或交界性可切除疾病的患者进行亚组分析显示，与对照组相比，ipp - ptx组的总生存率显著提高(21.3个月vs 14.7个月，风险比；0.532, p = 0.033)。ipp - ptx组的转换手术发生率高于对照组（24% vs. 4%, p = 0.006）。结论ipp PTX方案可延长PFS，但不能延长总生存期，亚组分析提示原发肿瘤分类为可切除/交界性可切除的隐匿性腹膜播散患者的生存获益可能性。

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