Erschienen in:
20.05.2023 | Original Article
Scoring model with serum albumin and CA19-9 for metastatic pancreatic cancer in second-line treatment: results from the NAPOLEON study
verfasst von:
Azusa Komori, Satoshi Otsu, Mototsugu Shimokawa, Taiga Otsuka, Futa Koga, Yujiro Ueda, Junichi Nakazawa, Shiho Arima, Masaru Fukahori, Yoshinobu Okabe, Akitaka Makiyama, Hiroki Taguchi, Takuya Honda, Taro Shibuki, Kenta Nio, Yasushi Ide, Norio Ureshino, Toshihiko Mizuta, Tsuyoshi Shirakawa, Kenji Mitsugi
Erschienen in:
International Journal of Clinical Oncology
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Ausgabe 8/2023
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Abstract
Background
Patients with metastatic pancreatic cancer refractory to first-line chemotherapy (CTx) have few treatment options. It is unclear what kind of patients could be brought about survival benefit by 2nd-line CTx after refractory to gemcitabine + nab-PTX (GnP) or FOLFIRINOX.
Methods
This analysis was conducted as part of a multicenter retrospective study of GnP or FOLFIRINOX in patients with metastatic pancreatic cancer. Excluding censored cases, 156 and 77 patients, respectively, received second-line chemotherapy (CTx) and best supportive care (BSC). Using prognostic factors for post-discontinuation survivals (PDSs) at the first-line determination in multivariate analysis, we developed a scoring system to demonstrate the benefit of second-line CTx.
Results
The second-line CTx group had a median PDS of 5.2 months, whereas the BSC group had a median PDS of 2.7 months (hazard ratio 0.42; 95% confidence interval [CI] 0.31–0.57; p < 0.01). According to the Cox regression model, serum albumin levels below 3.5 g/dL, and CA19-9 levels above 1000 U/mL were independent prognostic factors (p < 0.01). Serum albumin (≥ and < 3.5 g/dL allotted to scores 0 and 1) and CA19-9 (< and ≥ 1000 U/mL allotted to scores 0 and 1) at first-line determination were used to develop the scoring system. The PDSs of patients with scores of 0 and 1 were significantly better than those of the BSC group; however, there was no significant difference between the PDSs of patients with score 2 and the BSC group.
Conclusion
The survival advantage of second-line CTx, was observed in patients with scores of 0 and 1 but not in those with score 2.