Clinical Study Of Adjuvant Chemotherapy Of Gemcitabine Monotherapy Or Nab-paclitaxel Combined With Gemcitabine After Radical Operation Of Pancreatic Cancer

Objective:To explore the clinical efficacy and safety of adjuvant chemotherapy with nab-paclitaxel combined with gemcitabine or gemcitabine monoadjuvant chemotherapy after radical operation of pancreatic cancer Methods:The Pancreatic Cancer Chemotherapy Database of the Second Department of Hepatobiliary and Pancreatic Surgery of the First Hospital of Jilin University was reviewed,43 patients underwent adjuvant chemotherapy with gemcitabine(G)regimen and nab-paclitaxel combined with gemcitabine(AG)regimen after radical resection of pancreatic cancer from December 2018 to June 2020 was selected based on the inclusion and exclusion criteria,including 23 people in the AG group and 20 people in the G group.The patient’s gender,age,body mass index(BMI),preoperative CA199,history of hypertension,history of diabetes,history of coronary heart disease,tumor location,postoperative pathology,presence or absence of nerves,vascular invasion,degree of differentiation,clinical stage,and date of surgery basic information such as the start and end dates of chemotherapy and the completion of chemotherapy were collected.A statistical analysis of the basic information of the two groups of patients shows that the baseline difference between the two groups of patients was not statistically significant.According to the follow-up data,the patient’s recurrence and metastasis status and time,total follow-up time,chemotherapy adverse reactions(leukopenia,neutropenia,thrombocytopenia,anemia,nausea,vomiting,diarrhea,fatigue,fever,peripheral neuropathy)and grade,the disease-free survival(DFS)was used to evaluate the efficacy of the two chemotherapy regimens and serve as the main research endpoint.The safety is evaluated by the incidence and grade of chemotherapy-related adverse reactions.Data collation and statistical analysis of safety indicators and efficacy indicators.Results:AG regimen adjuvant chemotherapy group: The median follow-up time was 17.3months until January 30,2021.The median DFS(m DFS)was 14.9 months [95%confidence interval(CI): 12.2-17.6 months].5(22%)patients died during the period.The median OS(m OS)could not be calculated for insufficient follow-up time.G adjuvant chemotherapy group: The follow-up time is 7.1-22.9 months As of the last follow-up on January 30,2021,and the median follow-up time is 15.4 months.The m DFS was 12.0 months [95%CI: 11.1-12.9 months],and 4(20%)deaths occurred during the follow-up period.Statistical analysis shows that the AG program was longer than the G program m DFS and was statistically significant(14.9 months VS12.0 months,P=0.048).There were no related deaths during adjuvant chemotherapy,and the severity of adverse reactions ranged from 1-3.68 adverse reactions occurred in 18 patients(78.3%)in the AG regimen chemotherapy group,and 12 severe adverse reactions occurred in 5(21.7%)patients.42 adverse reactions occurred in 17 patients(85.0%)in the G regimen chemotherapy group,of which 3(15.0%)patients had 3serious adverse reactions.Adverse reactions with a higher incidence include(AG group vs.G group)peripheral neuropathy(47.8% vs 15.0%),leukopenia(43.3% vs35.0%),anemia(43.5% vs 35.0%),neutropenia(39.1% vs 30.0%),fatigue(30.4% vs25.0%).Statistical analysis shows that the difference in the incidence of adverse reactions of peripheral sensory nerve disorders between the two groups was statistically significant.The incidence of the AG regimen group was higher than that of the G regimen group(47.8% vs 15.0%,P=0.022),but grade 3 and above was only2(8.7%)cases.The incidence of other adverse reactions in the AG regimen was slightly higher than that in the G regimen,but statistical analysis shows that the difference was not statistically significant.Conclusion:In patients after pancreatic cancer resection,the use of AG regimen adjuvant chemotherapy can prolong their DFS compared with the G single-agent regimen.Although it will increase the incidence of peripheral sensory nerve disorders,there are no significant differences in other adverse reactions.The overall adverse reactions of chemotherapy are safe and controllable.Since this study is a single-center retrospective study and the sample size is small,there may be selection bias,and the current follow-up time cannot calculate the m OS,but the AG regimen is still a potentially feasible adjuvant chemotherapy regimen for patients with pancreatic cancer.