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Systemic Chemotherapy With or Without Hepatic Arterial Infusion Chemotherapy for Liver Metastases From Pancreatic Cancer: A Propensity Score Matching Analysis

  • Huaqiang Ouyang
    Affiliations
    Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

    National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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  • Weidong Ma
    Affiliations
    National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China

    Department of Pancreatic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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  • Tongguo Si
    Affiliations
    National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China

    Department of Interventional Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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  • Donglin Liu
    Affiliations
    Department of Mathematics, Lund University, Lund, Sweden
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  • Ping Chen
    Affiliations
    National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China

    Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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  • Anna Sandström Gerdtsson
    Affiliations
    Department of Immunotechnology, CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
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  • Jiahong Song
    Affiliations
    Department of Cardiology, The second hospital of Jiaxing, Jiaxing, Zhejiang, China
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  • Yue Ni
    Affiliations
    The Nursing Department, Beijing Bo Ai Hospital, China Rehabilitation Research Center, Beijing, China
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  • Juanjuan Luo
    Affiliations
    NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
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  • Zhuchen Yan
    Correspondence
    Address for correspondence: Zhuchen Yan, MD, Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital. Tianjin, China
    Affiliations
    Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

    National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Published:November 10, 2022DOI:https://doi.org/10.1016/j.clcc.2022.10.007

      Abstract

      Background

      The significance of systemic chemotherapy (SCT) combined with hepatic arterial infusion (HAI) chemotherapy in the treatment of pancreatic ductal adenocarcinoma with liver metastases (PACLM) remains unclear. Based on previous studies, this single-center propensity score matching (PSM) study aimed to explore the efficacy of SCT with or without HAI for PACLM.

      Patient and Methods

      The PSM method was used to screen 661 cases of PACLM who received SCT at Tianjin Medical University Cancer Institute and Hospital from 2001 to 2020. According to the 1:6 ratio with PSM, 385 patients were divided into the SCT+HAI group (n = 55) and the SCT group (n = 330). After a median follow-up of 49 (range 7-153) months, overall survival (OS) and survival-related prognostic factors were analyzed.

      Results

      The main baseline characteristics of the SCT+HAI group and the SCT alone group were matched appropriately (P > .05). After PSM, the median OS for patients in the 2 groups was 10.6 and 7.6 months, respectively (P = .02). Multivariate analysis revealed that peritoneal metastases (P = .03), CA199 ≥ 500U/mL (P = .03), and lactate dehydrogenase (LDH) ≥ 250U/L (P = .03) were prognostic factors of poor survival, modern SCT plus HAI (P = .04) was a protective factor.

      Conclusion

      Our findings indicated that adequate cycles of SCT+HAI result in better survival than SCT alone in patients with PACLM. Patients with peritoneal metastases, markedly elevated CA19-9 and LDH have a poorer prognosis. The conclusion has yet to be validated in randomized controlled clinical trials.

      Keywords

      Abbreviations:

      SCT (systemic chemotherapy), HAI (hepatic arterial infusion), PACLM (pancreatic ductal adenocarcinoma with liver metastases), PSM (propensity score matching), OS (overall survival), LDH (lactate dehydrogenase), PDAC (pancreatic ductal adenocarcinoma), HAIC (hepatic arterial infusion chemotherapy), HAIE (hepatic arterial infusionchemoembolization), CEA (carcinoembryonic antigen), TB (total bilirubin), CB (conjugated bilirubin), ALB (albumin), GGT (gamma-glutamyl transferase), ALT (alanine aminotransferase), ALP (alkaline phosphatase), RCT (randomized controlled trial), GEM (gemcitabine), OX (oxaliplatin), FU (fluorouracil), nab-PTX (nanoparticle albumin-bound paclitaxel), PARP (poly(adenosine diphosphate-ribose) polymerase), TMUCIH (Tianjin Medical University Cancer Institute and Hospital), KPS (Karnofsky performance status), MRI (magnetic resonance imaging)
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