Helm James, Centeno Barbara A, Coppola Domenico, Melis Marcovalerio, Lloyd Mark, Park Jong Y, Chen Dung-Tsa, Malafa Mokenge P
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
Cancer. 2009 Sep 15;115(18):4080-9. doi: 10.1002/cncr.24503.
American Joint Committee on Cancer (AJCC) anatomic stage group is considered relatively nondiscriminatory for predicting differences in survival after pancreatectomy for ductal adenocarcinoma, a perception confirmed in the authors' patients and by other reports. The authors' aim was to investigate the potential for improving the predictive value of AJCC staging by incorporating individually predictive histologic features into AJCC tumor-node-metastasis classification of anatomic extent, and determine the simplest combination of tumor characteristics predicting survival.
The authors determined survival of 137 patients who underwent pancreatectomy for ductal adenocarcinoma with curative intent (stage Groups IA-IIB) at Moffitt Cancer Center during the last 2 decades using data obtained from medical record review, the Moffitt Cancer Registry, and the Social Security Death Index. Histologic characteristics were confirmed by expert review.
Median survival was 21.2 months after pancreatectomy with a 3-year disease-specific survival of 36%. Univariate Kaplan-Meier analysis and multivariate Cox proportional hazard modeling found worse survival with local extrapancreatic extension, poorly differentiated histology, and lymphatic invasion within tumor (P<.05). Survival was not worse with nodal metastases, microscopically positive resection margins, and perineural or venous invasion, nor was survival better with cancer arising from an intraductal papillary mucinous neoplasm. Kaplan-Meier estimates for different variable combinations showed prognosis was best for well- or moderately differentiated tumors without lymphatic invasion and confined to the pancreas (9.9 years median survival), worst for poorly differentiated tumors with lymphatic invasion and local extension beyond the pancreas (8.5 months median survival), and intermediate for well- or moderately differentiated tumors with either lymphatic invasion or local extension beyond the pancreas (21.2 months median survival).
A simple combination of tumor differentiation, lymphatic invasion within the tumor, and local extrapancreatic extension predicts survival after pancreatectomy for ductal adenocarcinoma.
美国癌症联合委员会（AJCC）解剖学分期分组在预测导管腺癌胰腺切除术后的生存差异方面被认为相对缺乏区分性，作者的患者及其他报告均证实了这一观点。作者的目的是通过将个体预测性组织学特征纳入AJCC肿瘤-淋巴结-转移（TNM）解剖范围分类，来研究提高AJCC分期预测价值的潜力，并确定预测生存的最简单肿瘤特征组合。
作者利用从病历审查、莫菲特癌症登记处和社会保障死亡指数获得的数据，确定了过去20年在莫菲特癌症中心接受根治性胰腺切除术（IA-IIB期组）的137例导管腺癌患者的生存情况。组织学特征经专家审查确认。
胰腺切除术后的中位生存期为21.2个月，3年疾病特异性生存率为36%。单因素Kaplan-Meier分析和多因素Cox比例风险模型发现，局部胰腺外扩展、组织学分化差和肿瘤内淋巴侵犯的患者生存较差（P<0.05）。有淋巴结转移、显微镜下切缘阳性以及神经周围或静脉侵犯的患者生存情况并不更差，导管内乳头状黏液性肿瘤起源的癌症患者生存情况也未更好。不同变量组合的Kaplan-Meier估计显示，预后最佳的是分化良好或中等分化、无淋巴侵犯且局限于胰腺的肿瘤（中位生存期9.9年），最差的是分化差、有淋巴侵犯且局部扩展至胰腺外的肿瘤（中位生存期8.5个月），分化良好或中等分化、有淋巴侵犯或局部扩展至胰腺外的肿瘤预后居中（中位生存期21.2个月）。
肿瘤分化、肿瘤内淋巴侵犯和局部胰腺外扩展的简单组合可预测导管腺癌胰腺切除术后的生存情况。
