Efficacy Of Chemotherapy And Prognostic Factors In Patients With Metastatic Duodenal Adenocarcinoma

Objective:This study aimed at assessing the efficacy of different first-line chemotherapyregimens in metastatic duodenal adenocarcinoma （mDA）, and exploring theprognostic factors..Method:56patients with mDA who at least received two cycles of chemotherapy in TheFirst Affiliated Hospital of Nanchang University between March2008and December2013were retrospectively analyzed. Patients were classified into four groupsaccording to first-line chemotherapy regimens: fluoropyrimidine monotherapy (groupA), fluoropyrimidine-oxaliplatin (group B), fluoropyrimidine-irinotecan(group C),gemcitabine-oxaliplatin (group D). The objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were evaluated using SPSS17.0.Meanwhile, the COX proportional hazards model was applied for multivariateanalysis of prognostic.Results:A total of56patients were enrolled in the study, the number of patients in eachgroup was as follows: group A,6patients; group B,19patients; group C,10patients;group D,21patients. In the entire population, the ORR was32.1%, the median PFSand OS times were5.4and12.9months, respectively. Median PFS (mPFS) timeswere as follows: group A,4.9months; group B,6.3months; group C,4.1months;group D,7.5months; Median OS (mOS) times were as follows: group A,10.6months; group B,13.2months; group C,10.4months; group D,15.3months; Patientsin group B and D achieved longer ORR, mPFS and mOS，but no significantdifference (P＞0.05). The toxicity was tolerable, and a toxicity grade of III-IV wasrare. In addition, hematologic and gastrointestinal toxicity were the most common.Multivariate analysis showed that the prognostic factors of PFS including ECOGperformance status, the baseline CA199level and tumor response; the prognosticfactors of OS including ECOG score, the baseline CEA level, the baseline CA199 level and surgery history.Conclusion:This study was the first to report the efficacy and safety of first-linechemotherapy in mDA. The results suggest that two-drug combination chemotherapyregimens has better efficacy, the toxicity was tolerable. mFOLFOX and GEMOXregimen reveal longer ORR, mPFS and mOS, but no statistical difference comparedwith other chemotherapy in this study. ECOG performance status, baseline CA199level and tumor response were independent prognostic factors for PFS. And ECOGperformance status, the baseline CEA level, the baseline CA199level and surgeryhistory were independent prognostic factors for OS.