Division of Oncologic Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
HPB (Oxford). 2008;10(5):371-6. doi: 10.1080/13651820802291233.
Pancreatic cancers of the body and tail (BT) appear to have poorer survival compared with head (HD) lesions. We hypothesized that potential disparities in outcome may be related to tumor location. Our objective was to examine the relationship between tumor location and survival.
The Surveillance, Epidemiology, and End Results registry identified 33,752 patients with pancreatic adenocarcinoma and 6443 patients who underwent cancer-directed surgery between 1988 and 2004. Differences in survival and relationships between tumor location and clinical factors were assessed. Multivariate analysis was performed to determine the prognostic significance of tumor location.
Median survival for the entire cohort was five months and was significantly lower for BT compared to HD lesions (four vs. six months, p<0.001). Distant metastases (67% vs. 36%, p<0.001) were greater and cancer-directed surgery (16% vs. 30%, p<0.001) was lower for BT tumors. Of 6443 resected patients, HD patients (n=5118) were younger, had a greater number of harvested lymph nodes, were more likely to be lymph node-positive, and had a higher proportion of T3/T4 lesions. Significant univariate predictors of survival included age, T-stage, number of positive and harvested lymph nodes. On multivariate analysis, BT location was a significant prognostic factor for decreased survival (OR 1.11, 95% CI 1.00-1.23, p=0.05).
Pancreatic BT cancers have a lower rate of resectability and poorer overall survival compared to HD lesions. Prospective large-cohort studies may definitively prove that tumor location is a prognostic factor for survival in patients with pancreatic cancer.
体尾部（BT）胰腺癌的生存情况似乎比头部（HD）病变更差。我们假设，结果的潜在差异可能与肿瘤位置有关。我们的目的是研究肿瘤位置与生存之间的关系。
监测、流行病学和最终结果登记处确定了 33752 名患有胰腺腺癌的患者和 6443 名在 1988 年至 2004 年间接受癌症定向手术的患者。评估了生存差异和肿瘤位置与临床因素之间的关系。进行多变量分析以确定肿瘤位置的预后意义。
整个队列的中位生存时间为五个月，BT 明显低于 HD 病变（四个月与六个月，p<0.001）。远处转移（67%与 36%，p<0.001）更大，BT 肿瘤的癌症定向手术（16%与 30%，p<0.001）较低。在 6443 例接受切除的患者中，HD 患者（n=5118）年龄较小，收获的淋巴结数量较多，淋巴结阳性的可能性较大，且 T3/T4 病变的比例较高。生存的显著单因素预测因素包括年龄、T 期、阳性和收获淋巴结的数量。多变量分析显示，BT 位置是生存时间缩短的显著预后因素（OR 1.11，95%CI 1.00-1.23，p=0.05）。
与 HD 病变相比，BT 胰腺癌的可切除率较低，整体生存率较差。前瞻性大队列研究可能可以明确证明肿瘤位置是胰腺癌患者生存的预后因素。
