Section of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Ann Surg Oncol. 2010 Feb;17(2):371-6. doi: 10.1245/s10434-009-0759-z. Epub 2009 Oct 23.
Improved outcomes have been associated with the use of adjuvant therapy after resection of pancreas adenocarcinoma. However, the frequency with which patients receive adjuvant therapy and the factors impacting its use remain largely undefined. We hypothesized that nonutilization of adjuvant therapy was primarily associated with patient comorbidity and onset of postoperative complications.
A prospectively maintained database was reviewed to identify patients who underwent potentially curative resection of histologically confirmed pancreas adenocarcinoma at our institution from January 1996 to May 2007. Clinicopathological data and postoperative treatment history were collected to identify variables associated with receipt of adjuvant therapy.
Of 119 patients, 33% did not receive adjuvant therapy. The frequency with which patients underwent adjuvant therapy did not change over time. On multivariate analysis, patient age 70 years or greater, major postoperative complications, distal pancreatectomy, absence of nodal metastases, and absence of perineural invasion were associated with decreased utilization of adjuvant therapy.
One-third of patients in this contemporary dataset of patients did not go on to receive adjuvant therapy. The likelihood of receiving adjuvant treatment is negatively impacted by the course of postoperative recovery. Moreover, the fact that adjuvant therapy was undertaken less often for older patients and patients with favorable pathological features highlights the selection bias impacting the decision to pursue postoperative therapy for this disease. This selective utilization of postoperative therapy for patients with adverse oncological characteristics is likely to bias any retrospective analysis attempting to measure the efficacy of adjuvant treatment for pancreas adenocarcinoma.
胰腺腺癌切除术后使用辅助治疗可改善预后。然而，患者接受辅助治疗的频率以及影响其使用的因素在很大程度上仍未确定。我们假设辅助治疗的未使用主要与患者的合并症和术后并发症的发生有关。
我们回顾了前瞻性维护的数据库，以确定 1996 年 1 月至 2007 年 5 月期间在我院接受经组织学证实的胰腺腺癌根治性切除术的患者。收集临床病理数据和术后治疗史，以确定与接受辅助治疗相关的变量。
在 119 名患者中，有 33%未接受辅助治疗。随着时间的推移，接受辅助治疗的患者频率没有变化。多因素分析显示，年龄≥70 岁、严重术后并发症、胰体尾切除术、无淋巴结转移和无神经周围侵犯与辅助治疗使用率降低有关。
在这个当代患者数据集的三分之一患者没有接受辅助治疗。术后恢复过程对接受辅助治疗的可能性有负面影响。此外，对于年龄较大的患者和具有有利病理特征的患者，辅助治疗的应用频率较低，这突出了影响对该疾病进行术后治疗决策的选择偏差。这种对具有不良肿瘤学特征的患者选择性地使用术后治疗可能会使任何试图衡量辅助治疗对胰腺腺癌疗效的回顾性分析产生偏差。
