Vento Pälvi, Mustonen Harri, Joensuu Timo, Kärkkäinen Päivi, Kivilaakso Eero, Kiviluoto Tuula
Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
World J Gastroenterol. 2007 Jun 7;13(21):2945-51. doi: 10.3748/wjg.v13.i21.2945.
To explore whether preoperative chemoradiation therapy improves survival of patients with pancreatic cancer undergoing resectional surgery.
Forty-seven patients with a malignant pancreatic tumor localized in the head or uncinate process of the pancreas underwent radical pancreatico-duodenectomy. Twenty-two received chemoradiation therapy (gemcitabine and radiation dose 50.4 Gy) before surgery (CRR) and 25 patients underwent surgery only (RO). The study was non-randomised. Patients were identified from a prospective database.
The median survival time was 30.2 mo in the CRR group and 35.9 mo in the RO group. No statistically significant differences were found in subclasses according to lymph node involvement, TNM stages, tumor size, or perineural invasion. The one, three and five year survival rates were 81%, 33% and 33%, respectively, in the CRR group and 72%, 47% and 23%, respectively, in the RO group. In ductal adenocarcinoma, the median survival time was 27 mo in the CRR group and 20 mo in the RO group. No statistically significant differences were found in the above subclasses. The one, three and five year survival rates were 79%, 21% and 21%, respectively, in the CRR group and 64%, 50% and 14%, respectively, in the RO group. The overall hospital mortality rate was 2%. The morbidity rate was 45% in the CRR group and 32% (NS) in the RO group.
Major multicenter randomized studies are needed to conclusively assess the impact of neoadjuvant treatment in the management of pancreatic cancer.
探讨术前放化疗是否能提高接受根治性手术的胰腺癌患者的生存率。
47例胰腺恶性肿瘤位于胰头或钩突的患者接受了根治性胰十二指肠切除术。22例患者在手术前接受了放化疗（吉西他滨和50.4 Gy的放射剂量）（CRR组），25例患者仅接受了手术（RO组）。该研究为非随机研究。患者来自一个前瞻性数据库。
CRR组的中位生存时间为30.2个月，RO组为35.9个月。根据淋巴结受累情况、TNM分期、肿瘤大小或神经周围侵犯情况进行亚组分析，未发现统计学上的显著差异。CRR组的1年、3年和5年生存率分别为81%、33%和33%，RO组分别为72%、47%和23%。在导管腺癌中，CRR组的中位生存时间为27个月，RO组为20个月。在上述亚组中未发现统计学上的显著差异。CRR组的1年、3年和5年生存率分别为79%、21%和21%，RO组分别为64%、50%和14%。总体医院死亡率为2%。CRR组的发病率为45%，RO组为32%（无统计学差异）。
需要进行大型多中心随机研究，以最终评估新辅助治疗在胰腺癌治疗中的影响。
