RU2745793C1 - Method for calculating life expectancy of patients with metastatic pancreatic adenocarcinoma - Google Patents
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- 230000001394 metastastic effect Effects 0.000 title claims abstract description 16
- 206010061289 metastatic neoplasm Diseases 0.000 title claims abstract description 16
- 238000000034 method Methods 0.000 title claims abstract description 6
- 206010052747 Adenocarcinoma pancreas Diseases 0.000 title abstract description 4
- 201000002094 pancreatic adenocarcinoma Diseases 0.000 title abstract description 4
- 230000006837 decompression Effects 0.000 claims abstract description 10
- 239000002184 metal Substances 0.000 claims abstract description 9
- 206010023129 Jaundice cholestatic Diseases 0.000 claims abstract description 6
- 201000005267 Obstructive Jaundice Diseases 0.000 claims abstract description 6
- 210000000496 pancreas Anatomy 0.000 claims description 10
- 208000009956 adenocarcinoma Diseases 0.000 claims description 8
- 206010003445 Ascites Diseases 0.000 claims description 4
- 206010027476 Metastases Diseases 0.000 claims description 3
- 210000004185 liver Anatomy 0.000 claims description 3
- 210000000056 organ Anatomy 0.000 claims description 2
- 230000009401 metastasis Effects 0.000 claims 1
- 239000003814 drug Substances 0.000 abstract description 5
- 238000004364 calculation method Methods 0.000 abstract description 3
- 238000002512 chemotherapy Methods 0.000 abstract 1
- 230000000694 effects Effects 0.000 abstract 1
- 239000000126 substance Substances 0.000 abstract 1
- 206010061902 Pancreatic neoplasm Diseases 0.000 description 7
- 208000015486 malignant pancreatic neoplasm Diseases 0.000 description 7
- 201000002528 pancreatic cancer Diseases 0.000 description 7
- 208000008443 pancreatic carcinoma Diseases 0.000 description 7
- 230000004083 survival effect Effects 0.000 description 4
- 206010028980 Neoplasm Diseases 0.000 description 3
- 238000001839 endoscopy Methods 0.000 description 3
- SDUQYLNIPVEERB-QPPQHZFASA-N gemcitabine Chemical compound O=C1N=C(N)C=CN1[C@H]1C(F)(F)[C@H](O)[C@@H](CO)O1 SDUQYLNIPVEERB-QPPQHZFASA-N 0.000 description 3
- 229960005277 gemcitabine Drugs 0.000 description 3
- 210000004698 lymphocyte Anatomy 0.000 description 3
- 210000000440 neutrophil Anatomy 0.000 description 3
- 238000010837 poor prognosis Methods 0.000 description 3
- 238000004393 prognosis Methods 0.000 description 3
- 108010058566 130-nm albumin-bound paclitaxel Proteins 0.000 description 2
- 102000003855 L-lactate dehydrogenase Human genes 0.000 description 2
- 108700023483 L-lactate dehydrogenases Proteins 0.000 description 2
- 210000003445 biliary tract Anatomy 0.000 description 2
- 229940079593 drug Drugs 0.000 description 2
- 230000002496 gastric effect Effects 0.000 description 2
- 230000007774 longterm Effects 0.000 description 2
- 238000010197 meta-analysis Methods 0.000 description 2
- 238000009099 neoadjuvant therapy Methods 0.000 description 2
- 229960001592 paclitaxel Drugs 0.000 description 2
- 201000008129 pancreatic ductal adenocarcinoma Diseases 0.000 description 2
- RCINICONZNJXQF-MZXODVADSA-N taxol Chemical compound O([C@@H]1[C@@]2(C[C@@H](C(C)=C(C2(C)C)[C@H](C([C@]2(C)[C@@H](O)C[C@H]3OC[C@]3([C@H]21)OC(C)=O)=O)OC(=O)C)OC(=O)[C@H](O)[C@@H](NC(=O)C=1C=CC=CC=1)C=1C=CC=CC=1)O)C(=O)C1=CC=CC=C1 RCINICONZNJXQF-MZXODVADSA-N 0.000 description 2
- 206010073365 Intraductal papillary mucinous carcinoma of pancreas Diseases 0.000 description 1
- 206010025327 Lymphopenia Diseases 0.000 description 1
- 206010027457 Metastases to liver Diseases 0.000 description 1
- 206010051676 Metastases to peritoneum Diseases 0.000 description 1
- 210000000941 bile Anatomy 0.000 description 1
- 201000011510 cancer Diseases 0.000 description 1
- 238000009096 combination chemotherapy Methods 0.000 description 1
- 230000000052 comparative effect Effects 0.000 description 1
- 231100001023 lymphopenia Toxicity 0.000 description 1
- 230000003211 malignant effect Effects 0.000 description 1
- 201000004754 pancreatic intraductal papillary-mucinous neoplasm Diseases 0.000 description 1
- 208000010918 peritoneal neoplasm Diseases 0.000 description 1
- 210000002966 serum Anatomy 0.000 description 1
- 238000009097 single-agent therapy Methods 0.000 description 1
- 230000000391 smoking effect Effects 0.000 description 1
- 239000000439 tumor marker Substances 0.000 description 1
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Abstract
Description
Изобретение относится к области медицины, а именно к онкологии, и предназначено для расчета продолжительности жизни у пациентов с метастатической аденокарциномой поджелудочной железы (МАПЖ) осложненной механической желтухой, на основании учета прогностических факторов, влияющих на предполагаемую продолжительность жизни. The invention relates to medicine, namely to oncology, and is intended for calculating life expectancy in patients with metastatic adenocarcinoma of the pancreas (PAA) complicated by obstructive jaundice, based on prognostic factors affecting the expected life expectancy.
В настоящее время для разрешения механической желтухи, вызванной аденокарциномой головки поджелудочной железы применяется ретроградное билиарное стентирование. При этом существует возможность использования пластикового стента (ПС) и саморасширяющегося металлического стента (CMC).Currently, retrograde biliary stenting is used to resolve obstructive jaundice caused by adenocarcinoma of the head of the pancreas. At the same time, there is the possibility of using a plastic stent (PS) and a self-expanding metal stent (CMC).
Каждый из стентов имеет свои преимущества и недостатки.Each of the stents has advantages and disadvantages.
Пластиковые стенты дешевле, однако период их функционирования значительно меньше металлических. Металлические стенты в несколько раз дороже, но обеспечивают более длительное желчеотведение, имея более продолжительный период функционирования. В ряде научных исследований доказано, что экономически эффективно применение металлических стентов при предполагаемой продолжительности жизни более 4 месяцев [Gardner ТВ, Spangler СС, Byanova KL, et al. Cost-effectiveness and clinical efficacy of biliary stents in patients undergoing neoadjuvant therapy for pancreatic adenocarcinoma in a randomized controlled trial. Gastrointest Endosc. 2016; 84(3):460-466. doi:10.1016/j.gie.2016.02.047; Adams MA, Anderson MA, Myles JD, Khalatbari S, Scheiman JM. Self-expanding metal stents (SEMS) provide superior outcomes compared to plastic stents for pancreatic cancer patients undergoing neoadjuvant therapy. J Gastrointest Oncol. 2012; 3(4):309-313. doi:10.3978/j.issn.2078-6891.2011.050; Choi JM, Kim JH, Kim SS, et al. A comparative study on the efficacy of covered metal stent and plastic stent in unresectable malignant biliary obstruction. Clin Endosc. 2012; 45(1):78-83. doi:10.5946/ce.2012.45.1.78; Dumonceau JM, Tringali A, Blero D, J, Laugiers R, Heresbach D, Costamagna G; European Society of Gastrointestinal Endoscopy. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012 Mar; 44(3):277-98. doi: 10.1055/s-0031-1291633. Epub 2012 Feb 1.].Plastic stents are cheaper, but their period of operation is much shorter than metal ones. Metal stents are several times more expensive, but provide a longer bile flow, having a longer period of operation. A number of scientific studies have proven that it is cost-effective to use metal stents with an expected life expectancy of more than 4 months [Gardner TV, Spangler CC, Byanova KL, et al. Cost-effectiveness and clinical efficacy of biliary stents in patients undergoing neoadjuvant therapy for pancreatic adenocarcinoma in a randomized controlled trial. Gastrointest Endosc. 2016; 84 (3): 460-466. doi: 10.1016 / j.gie.2016.02.047; Adams MA, Anderson MA, Myles JD, Khalatbari S, Scheiman JM. Self-expanding metal stents (SEMS) provide superior outcomes compared to plastic stents for pancreatic cancer patients undergoing neoadjuvant therapy. J Gastrointest Oncol. 2012; 3 (4): 309-313. doi: 10.3978 / j.issn.2078-6891.2011.050; Choi JM, Kim JH, Kim SS, et al. A comparative study on the efficacy of covered metal stent and plastic stent in unresectable malignant biliary obstruction. Clin Endosc. 2012; 45 (1): 78-83. doi: 10.5946 / ce.2012.45.1.78; Dumonceau JM, Tringali A, Blero D, J, Laugiers R, Heresbach D, Costamagna G; European Society of Gastrointestinal Endoscopy. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012 Mar; 44 (3): 277-98. doi: 10.1055 / s-0031-1291633. Epub 2012 Feb 1.].
Из литературных данных известно, что медиана общей выживаемости для пациентов с метастатической аденокарциноме поджелудочной железы, получающих монотерапию гемцитабином, колеблется от 5,7 до 6,8 месяцев [Goldstein D, El-Maraghi RH, Hammel P et al. nab-Paclitaxel plus gemcitabine for metastatic pancreatic cancer: Long-term survival from a phase III trial. J Natl Cancer Inst 2015; 107]. Выявлено три значимых фактора неблагоприятного прогноза: лимфопения, NLR (начальное соотношение нейтрофилов к лимфоцитам крови) более 5 и перитонеальный канцероматоз [Rochefort, Р., Lardy Cleaud, A., Sarabi, М., Desseigne, F., Cattey Javouhey, A., & de la Fouchardiere, C. (2019). Long Term Survivors in Metastatic Pancreatic Ductal Adenocarcinoma: A Retrospective and Matched Pair Analysis. The Oncologist, theoncologist.2018-0786. doi: 10.1634/theoncologist.2018-0786]. Мета-анализ показал, что повышенный уровень NLR связан с плохим прогнозом при раке поджелудочной железы [Yang J.J., Нu Z.G., Shi W.X., Deng Т., He S. Q., Yuan S.G. Prognostic significance of neutrophil to lymphocyte ratio in pancreatic cancer: a meta-analysis. World Journal of Gastroenterology. 2015; 21(9):2807-2815. doi: 10.3748/wjg.v21.i9.2807], также показано, что NLR более 5 связан с плохим прогнозом при метастатическом раке поджелудочной железы [Ventriglia J, Petrillo A, Huerta М, et al. Neutrophil to Lymphocyte Ratio as a Predictor of Poor Prognosis in Metastatic Pancreatic Cancer Patients Treated with Nab-Paclitaxel plus Gemcitabine: A Propensity Score Analysis. Gastroenterol Res Pract. 2018; 2018:2373868. Published 2018 Jun 10. doi: 10.1155/2018/2373868]. Также показано, что использование NLR в комбинации с онкомаркером Са19-9 является более значимым прогностическим фактором, чем отдельное использование только NLR [Song JY, Chen MQ, Guo JH, Lian SF, Xu ВН. Combined pretreatment serum CA19-9 and neutrophil-to-lymphocyte ratio as a potential prognostic factor in metastatic pancreatic cancer patients. Medicine (Baltimore). 2018; 97(4):e9707. doi:10.1097/MD.0000000000009707]. Значимыми факторамиFrom the literature it is known that the median overall survival for patients with metastatic adenocarcinoma of the pancreas receiving monotherapy with gemcitabine ranges from 5.7 to 6.8 months [Goldstein D, El-Maraghi RH, Hammel P et al. nab-Paclitaxel plus gemcitabine for metastatic pancreatic cancer: Long-term survival from a phase III trial. J Natl Cancer Inst 2015; 107]. Three significant factors of unfavorable prognosis were identified: lymphopenia, NLR (initial neutrophil to blood lymphocyte ratio) more than 5 and peritoneal carcinomatosis [Rochefort, R., Lardy Cleaud, A., Sarabi, M., Desseigne, F., Cattey Javouhey, A. , & de la Fouchardiere, C. (2019). Long Term Survivors in Metastatic Pancreatic Ductal Adenocarcinoma: A Retrospective and Matched Pair Analysis. The Oncologist, theoncologist. 2018-0786. doi: 10.1634 / theoncologist.2018-0786]. A meta-analysis showed that an increased NLR level is associated with a poor prognosis in pancreatic cancer [Yang JJ, Hu ZG, Shi WX, Deng T., He SQ, Yuan SG Prognostic significance of neutrophil to lymphocyte ratio in pancreatic cancer: a meta- analysis. World Journal of Gastroenterology. 2015; 21 (9): 2807-2815. doi: 10.3748 / wjg.v21.i9.2807], it has also been shown that NLR greater than 5 is associated with poor prognosis in metastatic pancreatic cancer [Ventriglia J, Petrillo A, Huerta M, et al. Neutrophil to Lymphocyte Ratio as a Predictor of Poor Prognosis in Metastatic Pancreatic Cancer Patients Treated with Nab-Paclitaxel plus Gemcitabine: A Propensity Score Analysis. Gastroenterol Res Pract. 2018; 2018: 2373868. Published 2018 Jun 10. doi: 10.1155 / 2018/2373868]. It has also been shown that the use of NLR in combination with the Ca19-9 tumor marker is a more significant prognostic factor than the use of NLR alone [Song JY, Chen MQ, Guo JH, Lian SF, Xu BH. Combined pretreatment serum CA19-9 and neutrophil-to-lymphocyte ratio as a potential prognostic factor in metastatic pancreatic cancer patients. Medicine (Baltimore). 2018; 97 (4): e9707. doi: 10.1097 / MD.0000000000009707]. Significant factors
неблагоприятного прогноза являются: индекс Карновского менее 80, асцит, табакокурение, размер первичной опухоли более 5 см и уровень лактатдегидрогеназа (ЛДГ) более 250 ЕД/л со средней медианой выживаемости 3,6 мес. [Masao Tanaka, Carlos Castillo, TerumiKamisawa, Jin Young Jang, Philippe Levy, Takao Ohtsuka,Roberto Salvia, Yasuhiro Shimizu, Minoru Tada, Christopher L. Wolfgang. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology, Volume 17, Issue 5, 2017, pp. 738-753]. Также показано, что прогноз зависит от того, куда метастазирует опухоль: медиана выживаемости при экстрагепатических метастазах 7,5 мес., при метастазах в печень 4,8 мес., при метастазах в печень и другие органы 2,4 мес. [Kim HW, Lee JC, Paik KH, Lee YS, Hwang JH, Kim J. Initial Metastatic Site as a Prognostic Factor in Patients With Stage IV Pancreatic Ductal Adenocarcinoma. Medicine (Baltimore). 2015; 94(25):e1012. doi:10.1097/MD.0000000000001012].unfavorable prognosis are: Karnovsky index less than 80, ascites, smoking, primary tumor size more than 5 cm and lactate dehydrogenase (LDH) level more than 250 U / L with an average median survival of 3.6 months. [Masao Tanaka, Carlos Castillo, TerumiKamisawa, Jin Young Jang, Philippe Levy, Takao Ohtsuka, Roberto Salvia, Yasuhiro Shimizu, Minoru Tada, Christopher L. Wolfgang. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology, Volume 17, Issue 5, 2017, pp. 738-753]. It was also shown that the prognosis depends on where the tumor metastasizes: the median survival rate for extrahepatic metastases is 7.5 months, for liver metastases 4.8 months, for metastases in the liver and other organs, 2.4 months. [Kim HW, Lee JC, Paik KH, Lee YS, Hwang JH, Kim J. Initial Metastatic Site as a Prognostic Factor in Patients With Stage IV Pancreatic Ductal Adenocarcinoma. Medicine (Baltimore). 2015; 94 (25): e1012. doi: 10.1097 / MD.0000000000001012].
Таким образом, для онколога является принципиально важным расчет предполагаемой продолжительности жизни для выбора того или иного вида билиарного стента.Thus, for an oncologist, it is fundamentally important to calculate the expected life expectancy for choosing a particular type of biliary stent.
Предлагаемый нами способ выбора стента для декомпрессии билиарного тракта у пациентов с метастатической аденокарциномой поджелудочной железы осложенной механической желтухой не имеет аналогов и очень важен для использования в клинической практике.The proposed method for choosing a stent for decompression of the biliary tract in patients with metastatic adenocarcinoma of the pancreas complicated by obstructive jaundice has no analogues and is very important for use in clinical practice.
Предполагаемая продолжительность жизни у пациентов с метастатической аденокарциномой поджелудочной железы рассчитывается следующим образом.Life expectancy in patients with metastatic pancreatic adenocarcinoma is calculated as follows.
L (мес.)=(6×А - В±С±Д)×Е, гдеL (month) = (6 × A - B ± C ± D) × E, where
L - предполагаемая продолжительность жизни в месяцах;L is the estimated life expectancy in months;
А, В, С, Д, Е - коэффициенты из таблицы 1.A, B, C, D, E - coefficients from table 1.
Сущность изобретения состоит в том, что разработанный способ выбора стента для билиарной декомпрессии при метаститической аденокарциноме поджелудочной железы осложненной механической желтухой позволит персонифицировать выбор стента для декомпрессии билиарного тракта, что имеет важное практическое значение. Так, при предполагаемой продолжительности жизни менее 4 месяцев для билиарной декомпрессии целесообразно использовать пластиковый стент; при предполагаемой продолжительности жизни более 4 месяцев методом выбора является использование саморасширяющегося металлического стента.The essence of the invention lies in the fact that the developed method of selecting a stent for biliary decompression in metastatic adenocarcinoma of the pancreas complicated by obstructive jaundice will make it possible to personalize the choice of a stent for decompression of the biliary tract, which is of practical importance. So, with an expected life expectancy of less than 4 months, it is advisable to use a plastic stent for biliary decompression; with a life expectancy of more than 4 months, a self-expanding metal stent is the treatment of choice.
Применение изобретения позволяет получить следующий технический результат:Application of the invention allows to obtain the following technical result:
1. Рассчитать предполагаемую продолжительность жизни у больного с метастатической аденокарциноме поджелудочной железы.1. Calculate the expected life expectancy in a patient with metastatic adenocarcinoma of the pancreas.
2. Осуществить пациенториентированный выбор билиарного стента.2. Carry out patient-oriented selection of a biliary stent.
3. Подготовить пациента к проведению полихимиотерапии.3. Prepare the patient for polychemotherapy.
4. Исключить нецелевое расходование средств медицинского назначения.4. Eliminate the misuse of medical supplies.
Данное изобретение представляет собой законченную формулу расчета предполагаемой продолжительности жизни полностью готовую к работе.This invention is a complete formula for calculating the expected life expectancy completely ready to work.
Простота расчета делает формулу применимой в стационарах различного уровня.The simplicity of the calculation makes the formula applicable in hospitals of various levels.
Данный способ расчета предполагаемой продолжительности жизни применялся при расчете продолжительности жизни у 50 пациентов с метаститической аденокарциноме поджелудочной железы. Погрешность расчета составила 0,5 мес., что делает возможным ее применение в клинической практике.This method of calculating life expectancy was used to calculate life expectancy in 50 patients with metastatic adenocarcinoma of the pancreas. The calculation error was 0.5 months, which makes it possible to use it in clinical practice.
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Citations (3)
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| RU2648442C1 (en) * | 2017-04-12 | 2018-03-26 | Федеральное государственное бюджетное научное учреждение "Томский национальный исследовательский медицинский центр" Российской академии наук ("Томский НИМЦ") | Method for predicting lymphatic cancer spread in pancreatic ductual adenocarcinoma |
| WO2018112428A1 (en) * | 2016-12-15 | 2018-06-21 | Board Of Regents, The University Of Texas System | Methods for the detection and treatment of pancreatic ductal adenocarcinoma |
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Patent Citations (3)
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|---|---|---|---|---|
| WO2018112428A1 (en) * | 2016-12-15 | 2018-06-21 | Board Of Regents, The University Of Texas System | Methods for the detection and treatment of pancreatic ductal adenocarcinoma |
| RU2648442C1 (en) * | 2017-04-12 | 2018-03-26 | Федеральное государственное бюджетное научное учреждение "Томский национальный исследовательский медицинский центр" Российской академии наук ("Томский НИМЦ") | Method for predicting lymphatic cancer spread in pancreatic ductual adenocarcinoma |
| RU2699277C1 (en) * | 2018-06-18 | 2019-09-04 | Федеральное государственное бюджетное учреждение "Ростовский научно-исследовательский онкологический институт" Министерства здравоохранения Российской Федерации | Method of diagnosing pancreatic adenocarcinoma and metastases in its parenchyma |
Non-Patent Citations (3)
| Title |
|---|
| Schneider G. et al. Pancreatic cancer: basic and clinical aspects, Gastroenterology,128, 2005, p. 1606-1625. * |
| Тавобилов М. М. и др. Разработка математической модели прогнозирования продолжительности жизни больных раком поджелудочной железы, Вестник НМХЦ им. Н.И. ПИРОГОВА, 8(1), 2013, с. 103-106. * |
| Тавобилов М. М. и др. Разработка математической модели прогнозирования продолжительности жизни больных раком поджелудочной железы, Вестник НМХЦ им. Н.И. ПИРОГОВА, 8(1), 2013, с. 103-106. Schneider G. et al. Pancreatic cancer: basic and clinical aspects, Gastroenterology,128, 2005, p. 1606-1625. * |
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