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Master Thesis

Adénocarcinome du pancréas localement avancé ou métastatique : facteurs prédictifs de survie à 6 mois chez les patients traités par une deuxième ligne de chimiothérapie

Abstract : Introduction: By 2030, pancreatic adenocarcinoma will become the second leading cause of deaths by cancer in Europe, only 15 to 20% can benefit surgical resection. In metastatic pancreatic adenocarcinoma, FOLFIRINOX and GEMCITABINENAB-PACLITAXEL have shown significant improvement in overall survival and quality of life allowing access to second line chemotherapy up to 40 to 50% of our patients. The aim of our study was to identify predictive factors of 6 months survival and the overall survival prognosis factors in patients receiving second line chemotherapy. Materials and methods: Retrospective monocentric study on patients diagnosed with locally advanced and metastatic pancreatic adenocarcinoma receiving second line chemotherapy between January 2011 and December 2018. Assessed variables were included in a univariate and multivariate analysis with logistic regression model for predictive factors below or equal to 6 months with second line chemotherapy. Overall survival prognosis factors were included in a Cox model. A prognosis model was constructed based on the independent prognosis factors found in the multivariate Cox model. Results: We included 110 patients. Survival >6 months group had 53 patients whereas survival ≤6 months group had 57 patients Median overall survival after receiving second line chemotherapy was 6.33 months (5.03-7.67). Multivariate analysis has shown that predictive factors of survival ≤6 months was weight loss between baseline weight before diagnosis and weight at the beginning of second line chemotherapy (OR=1.55, CI95% [1.14-2.10], p=0.005), ECOG-PS>1 (OR=7.77, CI95% [1.63-37.15], p=0.017) and BMI (OR=0.92, IC95% [0.85-0.99], p=0.047). In multivariate analysis, independent prognostic factors for mortality was weight loss (HR=1.19, CI95% [1.02-1.40], p=0.029), abnormal bilirubin levels >20 μmol/L (HR=3.20, C95% [1.14-8.99], p=0.027), CA 19.9 level >200 IU/mL (HR=2.75, CI95% [1.21-6.24], p=0.016) and absence of prior tumor resection. (HR=0.42, CI95% [0.21-0.84], p=0.014). Conclusion: Second line chemotherapy has to be discussed in cases of important weight loss, ECOG-PS>1, high bilirubin level, CA19.9 level>200IU/mL.
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Submitted on : Wednesday, April 21, 2021 - 2:23:18 PM
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  • HAL Id : dumas-03204361, version 1

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Nicolas Lee. Adénocarcinome du pancréas localement avancé ou métastatique : facteurs prédictifs de survie à 6 mois chez les patients traités par une deuxième ligne de chimiothérapie. Médecine humaine et pathologie. 2020. ⟨dumas-03204361⟩

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