白蛋白结合型紫杉醇联合吉西他滨动脉灌注治疗进展期胰腺癌的安全性和有效性回顾性研究

背景与目的：白蛋白结合型紫杉醇联合吉西他滨（nab-paclitaxel combined with gemcitabine，AG）方案静脉化疗是进展期胰腺癌有效治疗方案之一，动脉灌注化疗（transcatheter arterial chemotherapy，TAC）具有增强疗效并降低不良反应的优势，观察AG方案经TAC治疗进展期胰腺癌患者的有效性和安全性。方法：回顾性分析2016年1月—2019年6月复旦大学附属肿瘤医院收治的63例接受治疗的进展期胰腺癌患者，患者均经病理学检查确诊为胰腺导管腺癌，其中Ⅲ期15例，Ⅳ期48例，所有患者接受经动脉灌注化疗和（或）栓塞治疗，动脉灌注化疗用药方案为盐酸吉西他滨1 000 mg/m ² 联合白蛋白结合型紫杉醇125 mg/m ² ，灌注时间≥10 min，伴有肝转移者同时行供血动脉栓塞。结果：63例患者中，术中行数字减影血管造影（digital subtraction angiography，DSA）可见胰腺肿瘤和肝转移灶动脉供血比例分别为66.67%和35.29%；接受治疗1次4例，2次6例，3次6例，4次及以上47例，治疗次数最多为9次，间隔时间为21～45 d。1年生存率为36.51%，中位生存期（median overall survival，mOS）为9.2个月，6个月无进展生存（progression-free survival，PFS）率为44.44%，中位PFS（median PFS，mPFS）为4.7个月。多因素分析显示KPS≥80、Ⅲ期与较长的生存期相关，接受多次动脉灌注化疗和（或）栓塞是良好的生存预后相关因素。发生治疗相关的Ⅲ度及以上血液学不良反应包括中性粒细胞减少（3.17%）和血小板下降（4.76%），非血液学不良反应包括乏力（6.35%）、恶心呕吐（9.52%）、腹泻（4.76%）和转氨酶升高（4.76%）；17.46%和22.22%的患者出现发热及肝区疼痛栓塞综合征，所有不良反应经治疗后均好转，无治疗相关性死亡病例。结论：白蛋白结合型紫杉醇联合吉西他滨经动脉灌注治疗进展期胰腺癌具有较好的安全性，不良反应与静脉给药相比有所减少，可有效地控制病情，使患者生存获益。

Efficacy and safety of nab-paclitaxel plus gemcitabine in the treatment of advanced pancreatic cancer by transcatheter arterial chemotherapy: a retrospective study

Background and purpose: Intravenous chemotherapy of nab-paclitaxel combined with gemcitabine (AG) is one of the effective treatment options for advanced pancreatic cancer, and transcatheter arterial chemotherapy (TAC) has the advantage of enhancing efficacy and reducing side effects. This study aimed to evaluate the efficacy and safety of AG regimen in the treatment of advanced pancreatic cancer by transcatheter arterial chemotherapy/chemoembolization (TAC/TACE). Methods: We retrospectively analyzed 63 advanced pancreatic cancer patients who were treated at Fudan University Shanghai Cancer Center from Jan. 2016to Jun. 2019. All patients received arterial infusion chemotherapy and/or embolization, and the TAC regimen consisted of nab-paclitaxel 125 mg/m ² combined with gemcitabine hydrochloride 1 000 mg/m ² , perfusion ≥10 minutes. If accompanied by liver metastasis, embolization was implemented. Results: Among 63 patients, the arterial blood supply ratios of pancreatic tumors and liver metastases in digital subtraction angiography (DSA) were 66.67% and 35.29% respectively. Four patients received treatment once, 6 patients received treatment twice, 6 patients received treatment 3 times, and 47 patients received treatment 4 times or more. The maximum number of treatment was 9 times, with an interval of 21-45 d. The 1-year overall survival (OS) rate was 36.51%. Median OS (mOS) was 9.2 months. The 6-month progression-free survival (PFS) rate was 44.44%, and the median PFS (mPFS) was 4.7 months. Multivariate analysis showed that KPS≥80 and stage Ⅲ were associated with longer survival, and multiple TAC/TACE treatment was suggested as good prognostic factor. Conclusion: AG has better safety in the treatment of pancreatic cancer by transarterial infusion chemotherapy. Compared with intravenous chemotherapy, AG can reduce the adverse reactions, effectively control the disease and prolong patients' survival.