Tani Masaji, Kawai Manabu, Miyazawa Motoki, Hirono Seiko, Ina Shinomi, Nishioka Ryohei, Fujita Yoichi, Uchiyama Kazuhisa, Yamaue Hiroki
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Langenbecks Arch Surg. 2009 Mar;394(2):249-53. doi: 10.1007/s00423-008-0296-4. Epub 2008 Mar 15.
Prognosis of the patients with pancreatic adenocarcinoma is still poor due to a recurrence, and liver metastasis is a distant metastasis that is foreboded the short survival period.
Between 1999 and 2005, 68 patients for pancreatic adenocarcinoma underwent a pancreaticoduodenectomy (n = 17), a pylorus-preserving pancreaticoduodenectomy (n = 27), distal pancreatectomy (n = 22), or total pancreatectomy (n = 2) with an extensive lymph node dissection.
A tumor recurrence occurred to 55 patients (13 of the liver, 21 of the local recurrence, 16 of peritoneal dissemination, three of the lymph node, and two of lung). The low tumor grade and female demonstrated a risk factor for a liver metastasis (P = 0.043, P = 0.031). A logistic regression analysis demonstrated female (P = 0.02) and low tumor grade (P = 0.04) as independent risk factors for recurrence with liver metastasis. The median survival time (MST) was 13.6 months, and MST of patients with a liver metastasis as an initial recurrent site was 13.7 months; the liver metastasis as an initial recurrent site has no impact on the MST after pancreatic resection.
We concluded potentially supporting the hypothesis that even patients thought to be at higher risk of liver metastasis may still be given the chance of resection, considering the satisfying survival.
胰腺腺癌患者的预后因复发仍然很差,肝转移是一种预示生存期短的远处转移。
1999年至2005年期间,68例胰腺腺癌患者接受了胰十二指肠切除术(n = 17)、保留幽门的胰十二指肠切除术(n = 27)、远端胰腺切除术(n = 22)或全胰切除术(n = 2),并进行了广泛的淋巴结清扫。
55例患者出现肿瘤复发(肝转移13例、局部复发21例、腹膜播散16例、淋巴结转移3例、肺转移2例)。低肿瘤分级和女性是肝转移的危险因素(P = 0.043,P = 0.031)。逻辑回归分析显示女性(P = 0.02)和低肿瘤分级(P = 0.04)是肝转移复发的独立危险因素。中位生存时间(MST)为13.6个月,以肝转移作为初始复发部位的患者的MST为13.7个月;以肝转移作为初始复发部位对胰腺切除术后的MST没有影响。
我们得出结论,潜在地支持了这样的假设,即考虑到令人满意的生存期,即使被认为肝转移风险较高的患者仍可能有机会接受切除术。