关键词: 晚期十二指肠癌, 一线化疗, Cox回归分析, 预后因素

Abstract: ObjectiveTo explore the independent prognosis factors of longterm survival for patients of advanced duodenal cancer and evaluate the efficacy and safety of its firstline chemotherapy. 
MethodsFrom June 2008 to January 2016， a total of 40 advanced duodenal cancer patients were analyzed. Only 31 patients received chemotherapy， including 13 patients of GEMOX regimen， 13 patients of FOLFOX regimen， 2 patients of capecitabine regimen and 3 patients of gemcitabine regimen. The efficacy and safety were evaluated by RECIST 11 and NCICTC 40 criteria. Survival analysis was performed by using KaplanMeier method. Univariate analysis of prognosis was made by Logrank method. Multivariable analysis of prognosis was used by Cox proportional hazard regression model. 
ResultsThe total treatment cycle of chemotherapy was 146， and the median treatment cycle was 4（2.12 cycles）. CR was not observed. For GEMOX regimen， 1 case of PR and 10 cases of SD and 2 cases of PD were observed with disease control rate（DCR） of 84.6％. For FOLFOX regimen， 6 cases of SD and 7 cases of PD were observed with DCR of 46.2％. For capecitabine and gemcitabine regimen， 3 cases of SD and 2 cases of PD were observed with DCR of 60.0％. The median overall survival （OS） of chemotherapy and nonchemotherapy were 15.7 months and 4.4 months（P＜0.001）. The median OS of GEMOX， FOLFOX regimen and single drug group were 27.9 months， 15.2 months and 15.2 months（P=0656）. The median progressionfree survival （PFS） of GEMOX， FOLFOX regimen and single drug group were 7.8 months， 4.0 months and 51 months（P=0.053）. The major treatmentrelated side effects including leucopenia， neutropenia， anemia， fatigue， nausea and etc， were mainly in grade 12. In univariate analysis， depth of invasion， degree of differentiation， liver metastasis and chemotherapy correlated with the prognosis of the patients of advanced duodenal cancer （P＜0.05）. Multivariable analysis revealed that degree of differentiation， liver metastasis and chemotherapy were independent risk factors of prognosis. 
ConclusionGEMOX， FOLFOX， capecitabine and gemcitabine regimen were effective and welltolerated in firstline chemotherapy. GEMOX regimen may have a longer OS and PFS in firstline chemotherapy. Degree of differentiation， liver metastasis and chemotherapy may serve as dependent prognostic factors with advanced duodenal cancer， which can be used to guide the choice and practice of the therapy for advanced duodenal cancer.

Key words: Advanced duodenal cancer, Firstline chemotherapy, Cox regression analysis, Prognosis factors