Gastrointestinal endoscopy · 2025
Combined phosphorus-32 implantation and chemotherapy versus chemotherapy alone for locally advanced pancreatic cancer: a propensity score-weighted landmark analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Lim Amanda H, Nitchingham Darshan, Bednarz Jana, Bills Madison, Lanka Laxmi, Allen Berry, Tan Alvin, Joshi Rohit, Hsieh William, Crouch Benjamin, Zobel Joshua, Thomson John-Edwin, Neo Euling, Safaeian Romina, Tse Edmund, Rayner Christopher K, Ruszkiewicz Andrew, Wong Jayden, Singhal Nimit, Bartholomeusz Dylan, Weilert Frank, Nguyen Nam Q
Аннотация
BACKGROUND AND AIMS: Combined standard chemotherapy and phosphorus-32 (32P) microparticle intratumoral implantation has revealed encouraging results in locally advanced pancreatic cancer (LAPC). We compared chemotherapy and 32P implantation with standard therapy (chemotherapy ± chemoradiotherapy) using a propensity score-weighted analysis (PSWA).
METHODS: We conducted a retrospective cohort study comparing clinical outcomes of combined chemotherapy and EUS-guided 32P implantation against standard therapy for patients with LAPC from 2 tertiary hospitals. Landmark analysis was used to address immortal time bias. PSWA was applied to reduce bias due to confounding. The primary outcome was overall survival within 30 months after first-line treatment initiation, with treatment effect expressed as restricted mean survival time (RMST).
RESULTS: One hundred four patients were considered. The landmark date was designated as 3 months after initiation of first-line chemotherapy. After excluding patients who died before the landmark or had 32P implantation after it, 86 patients were included (35 combination vs 51 standard). The RMST within 30 months after chemotherapy commencement was an estimated 189 days longer for patients with combination therapy (527.2 [95% CI, 437.8-634.8] vs 338.0 [95% CI 284.2-402], P = .002). The local progression-free RMST within 30 months was estimated to be 168.6 days longer (95% CI, 79.9-257.2), and the probability of downstaging was 23.9% higher (95% CI, 6.3-41.3; P = .008) in patients treated with combination therapy.
CONCLUSIONS: In this comparative study between combined chemotherapy and 32P microparticles implantation with standard chemotherapy for patients with LAPC, the combination showed better survival, disease control, and downstaging. The outcomes highlight the need for a randomized controlled trial.
METHODS: We conducted a retrospective cohort study comparing clinical outcomes of combined chemotherapy and EUS-guided 32P implantation against standard therapy for patients with LAPC from 2 tertiary hospitals. Landmark analysis was used to address immortal time bias. PSWA was applied to reduce bias due to confounding. The primary outcome was overall survival within 30 months after first-line treatment initiation, with treatment effect expressed as restricted mean survival time (RMST).
RESULTS: One hundred four patients were considered. The landmark date was designated as 3 months after initiation of first-line chemotherapy. After excluding patients who died before the landmark or had 32P implantation after it, 86 patients were included (35 combination vs 51 standard). The RMST within 30 months after chemotherapy commencement was an estimated 189 days longer for patients with combination therapy (527.2 [95% CI, 437.8-634.8] vs 338.0 [95% CI 284.2-402], P = .002). The local progression-free RMST within 30 months was estimated to be 168.6 days longer (95% CI, 79.9-257.2), and the probability of downstaging was 23.9% higher (95% CI, 6.3-41.3; P = .008) in patients treated with combination therapy.
CONCLUSIONS: In this comparative study between combined chemotherapy and 32P microparticles implantation with standard chemotherapy for patients with LAPC, the combination showed better survival, disease control, and downstaging. The outcomes highlight the need for a randomized controlled trial.