Department of Radiation Oncology and Molecular Radiation Sciences, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Hospital, Baltimore, MD 21231-2410, USA.
Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3):839-44. doi: 10.1016/j.ijrobp.2009.02.071. Epub 2009 Aug 3.
Intraductal papillary mucinous neoplasms are mucin-producing cystic neoplasms of the pancreas. One-third are associated with invasive carcinoma. We examined the benefit of adjuvant chemoradiotherapy (CRT) for this cohort.
Patients who had undergone pancreatic resection at Johns Hopkins Hospital between 1999 and 2004 were reviewed. Of these patients, 83 with a resected pancreatic mass were found to have an intraductal papillary mucinous neoplasm with invasive carcinoma, 70 of whom met inclusion criteria for the present analysis.
The median age at surgery was 68 years. The median tumor size was 3.3 cm, and invasive carcinoma was present at the margin in 16% of the patients. Of the 70 patients, 50% had metastases to the lymph nodes and 64% had Stage II disease. The median survival was 28.0 months, and 2- and 5-year survival rate was 57% and 45%, respectively. Of the 70 patients, 40 had undergone adjuvant CRT. Those receiving CRT were more likely to have lymph node metastases, perineural invasion, and Stage II-III disease. The 2-year survival rate after surgery with vs. without CRT was 55.8% vs. 59.3%, respectively (p = NS). Patients with lymph node metastases or positive surgical margins benefited significantly from CRT (p = .047 and p = .042, respectively). On multivariate analysis, adjuvant CRT was associated with improved survival, with a relative risk of 0.43 (95% confidence interval, 0.19-0.95; p = .044) after adjusting for major confounders.
Adjuvant CRT conferred a 57% decrease in the relative risk of mortality after pancreaticoduodenectomy for intraductal papillary mucinous neoplasms with an associated invasive component after adjusting for major confounders. Patients with lymph node metastases or positive margins appeared to particularly benefit from CRT after definitive surgery.
导管内乳头状黏液性肿瘤是胰腺的黏液性囊性肿瘤，其中三分之一伴有浸润性癌。我们研究了这种情况下辅助放化疗（CRT）的益处。
回顾了 1999 年至 2004 年期间在约翰霍普金斯医院接受胰腺切除术的患者。在这些患者中，发现 83 例胰腺肿块切除术后有导管内乳头状黏液性肿瘤伴浸润性癌，其中 70 例符合本分析的纳入标准。
手术时的中位年龄为 68 岁。肿瘤的中位大小为 3.3cm，16%的患者边缘有浸润性癌。在 70 例患者中，50%有淋巴结转移，64%有 II 期疾病。中位生存期为 28.0 个月，2 年和 5 年生存率分别为 57%和 45%。在 70 例患者中，40 例行辅助 CRT。接受 CRT 的患者更有可能有淋巴结转移、神经周围侵犯和 II-III 期疾病。手术加与不加 CRT 的 2 年生存率分别为 55.8%和 59.3%（p=NS）。有淋巴结转移或阳性手术切缘的患者从 CRT 中显著获益（p=0.047 和 p=0.042）。多变量分析显示，在调整主要混杂因素后，辅助 CRT 与生存改善相关，相对风险为 0.43（95%置信区间，0.19-0.95；p=0.044）。
在调整主要混杂因素后，对于伴有侵袭性成分的导管内乳头状黏液性肿瘤，辅助 CRT 使胰十二指肠切除术后的死亡率相对风险降低了 57%。有淋巴结转移或阳性切缘的患者在根治性手术后似乎特别受益于 CRT。
