研究背景
近年來癌症人數逐年升高，胰臟癌位居國內十大癌症之一，針對胰臟癌的治療，外科手術及化學治療扮演了很重要的角色，但胰臟癌的預後不佳，整體來說患者五年存活率不到5%，雖然目前有很多藥物(單一藥物或是合併藥物)用於治療胰臟癌但療效不一。
研究的目
藉由存活分析，探討胰臟癌患者的存活時間與預後因子，並進一步分析各項藥物組合、藥物單獨使用或併用對於影響胰臟癌病患存活之差異。
研究方法
收集南部某醫學中心自2010年1月至2016年12月底，診斷為胰臟癌之患者資料，透過存活分析探討相關死亡風險因子，並利用人口變項、腫瘤變項及治療變項作Cox比例風險模式。
研究結果
全部個案共有377筆，平均診斷年齡為66.15±12.8歲，其中男性有187位（49.6％）、女性有190位（50.4％），透過卡方分析腫瘤生長部位與性別、年齡不具有相關性；在癌症臨床分期方面，年齡不論是超過60歲或是小於60歲，透過卡方分析年齡與癌症期別呈現相關性(p=0.005)，本研究排除設限資料，死亡患者中位存活期為0.63年，有20%的個案存活超過一年；此外，有接受化療與未接受化療的組別，存活時間呈現統計上顯著差異(p<0.001)，但針對不同化療藥物組合，其存活時間則未呈現統計上的差異(p=0.056)。透過Cox regression分析各模型會影響胰臟癌存活率的相關危險因子有性別、癌症分期、是否手術、是否使用藥物、藥物組合。接受藥物治療對於影響死亡風險率有顯著差異(HR=0.23；p<0.001)，藥物治療組合中相較於gemcitabine，只有gemcitabine合併cisplatin這項組合有顯著差異(HR=1.98；p=0.032)，其餘用藥組合相較於單獨使用gemcitabine，對於影響死亡風險率並無顯著差異。
研究結論
本次研究結果顯示有接受手術及化療藥物可降低死亡風險率，雖然接受藥物可降低死亡風險率，但各藥物組合間對於影響死亡風險率的程度差異並不顯著，期待未來有更多的臨床試驗能更進一步的證實哪種藥物或組合，對於延長胰臟癌病患存活率是最有效益，以提供臨床照護最好的選擇。

Purpose: Pancreatic cancer is a devastating disease, with overall 5-year survival rates less than 5%. A majority of patients present with locally advanced/metastatic disease. The current treatment options for pancreatic cancer are surgery and chemotherapy. The aim of this study was to examine the different therapeutic approaches, and compare single agent with chemotherapy regimen.

Methods: This study included 377 patients with pancreatic cancer from 2010 to 2016. Survival functions were estimated with the Kaplan-Meier estimation method and assessed with the Log-rank test. Risk factors associated demographic, tumor, and treatment variables were assessed by the Cox proportional hazard models.

Results: There was no sufficient evidence to show survival differences among different chemotherapy regimens, but gemcitabine plus cisplatin result in worse overall survival time compared with gemcitabine alone. There was a significant survival benefit for surgical treatments over non-surgical treatments and chemotherapy over supportive care. Furthermore, there was no statistically significant difference in improving survival time among different chemotherapy regimens. Further randomized controlled trials are necessary to increase confidence in the estimation of effect and to assess the life quality of patients.

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