Gut and Liver https://doi.org/10.5009/gnl18419 Analysis of Clinical Predictive Factors Affecting the Outcome of 2nd Line Chemotherapy for Gemcitabine-Refractory Advanced Pancreatic Cancer
Author Information
Jeung Eun Lee1, Hee Seung Lee2, Moon Jae Chung 2, Jeong Youp Park 2, Seung Woo Park2, Si Young Song2, and Seungmin Bang1
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea1,2

Seungmin Bang
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Yonseiro 50-1 Seodaemungu, Seoul, South Korea
Tel: +82-02-2228-5221, Fax: +82-02-361-2125, E-mail: bang7028@yuhs.ac
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

Abstract
Background/Aims: The benefit of second-line chemotherapy (SL) after failed first-line chemotherapy(FL) in patients with advanced pancreatic cancer has not yet been established. We evaluated the clinicalcharacteristics affecting the benefits of SL therapy compared to basic supportive care (BSC), identifiedthe prognostic factors, and ultimately devised a model of clinical parameters to assist in making decisionbetween SL and BSC after the failure of gemcitabine-based FL. Methods: The records of patients whoreceived gemcitabine-based FL for advanced pancreatic cancer at Yonsei University Hospital betweenJanuary 2010 and December 2015 were retrospectively reviewed. Significant clinical parameters wereassessed for their potential as predictive factors. Results: SL patients received a longer duration of FLtreatment compared with BSC patients with median duration being 16.0 weeks (range, 8.0 to 26.0 weeks)and 8.0 weeks (range, 4.0 to 16.0 weeks), respectively (p< 0.001). When the SL group was stratified bytheir modified overall survival (mOS) (longer and shorter than 6 months), we found significantdifferences for several clinical factors, namely, metastasis to the peritoneum (p<0.001), number ofmetastases (p<0.001), thrombosis events (p=0.003), and level of CA19-9 (p=0.011). In multivariateanalysis, more than one site of metastasis, occurrence of thrombotic event during FL, and a CA 19-9level above 90 U/mL were significant independent prognostic factors for mOS in the SL group (p<0.05).When attempt was made to devise a prognostic nomogram, Harrell's C-index of the final prognosisprediction model was 0.62. Conclusions: SL may be beneficial for patients without peritonealmetastasis or thrombotic events who have a single metastasis and a level of CA19-9 less than 90 U/mL.This prognostic nomogram can be used to predict mOS before the administration of SL after the failureof gemcitabine-based FL.
Keywords: Pancreatic cancer; Second line chemotherapy; Prognostic model
Abstract
Background/Aims: The benefit of second-line chemotherapy (SL) after failed first-line chemotherapy(FL) in patients with advanced pancreatic cancer has not yet been established. We evaluated the clinicalcharacteristics affecting the benefits of SL therapy compared to basic supportive care (BSC), identifiedthe prognostic factors, and ultimately devised a model of clinical parameters to assist in making decisionbetween SL and BSC after the failure of gemcitabine-based FL. Methods: The records of patients whoreceived gemcitabine-based FL for advanced pancreatic cancer at Yonsei University Hospital betweenJanuary 2010 and December 2015 were retrospectively reviewed. Significant clinical parameters wereassessed for their potential as predictive factors. Results: SL patients received a longer duration of FLtreatment compared with BSC patients with median duration being 16.0 weeks (range, 8.0 to 26.0 weeks)and 8.0 weeks (range, 4.0 to 16.0 weeks), respectively (p< 0.001). When the SL group was stratified bytheir modified overall survival (mOS) (longer and shorter than 6 months), we found significantdifferences for several clinical factors, namely, metastasis to the peritoneum (p<0.001), number ofmetastases (p<0.001), thrombosis events (p=0.003), and level of CA19-9 (p=0.011). In multivariateanalysis, more than one site of metastasis, occurrence of thrombotic event during FL, and a CA 19-9level above 90 U/mL were significant independent prognostic factors for mOS in the SL group (p<0.05).When attempt was made to devise a prognostic nomogram, Harrell's C-index of the final prognosisprediction model was 0.62. Conclusions: SL may be beneficial for patients without peritonealmetastasis or thrombotic events who have a single metastasis and a level of CA19-9 less than 90 U/mL.This prognostic nomogram can be used to predict mOS before the administration of SL after the failureof gemcitabine-based FL.
Keywords: Pancreatic cancer; Second line chemotherapy; Prognostic model
Search for
Archives