Department of Surgery, University of Verona, Verona, Italy.
Ann Surg Oncol. 2011 Dec;18(13):3608-14. doi: 10.1245/s10434-011-1769-1. Epub 2011 May 17.
The value of splenic vessels invasion (which identified T3 tumors) in prognosis after resection for pancreatic ductal adenocarcinoma (PDA) of the body and tail has not been extensively investigated. The goal of this study was to evaluate prognostic factors in PDA of the body/tail, emphasizing the role of splenic vessels infiltration.
Between 1990 and 2008, 87 patients who underwent distal pancreatectomy (DP) for histologically proven PDA of the body and tail were analyzed. Clinicopathological prognostic factors for survival were evaluated. Univariate and multivariable analyses were performed.
Postoperative morbidity was 31% with no mortality. The 1-, 3-, and 5-year overall survival rates were 77%, 48%, and 24.5%, respectively. Invasion of the splenic artery (SA) was observed in 19 patients (22%). Patients with SA invasion had a significantly poorer prognosis compared with those without SA invasion (median survival: 15 vs. 39 months, P = 0.014). On multivariable analysis, adjuvant therapy, poor differentiation (G3/G4), R2 resection, the presence of lymph node metastases, and SA invasion were independent predictors of survival.
Along with other well-known prognostic factors, invasion of SA is an independent predictor of poor survival in PDA of the body/tail. In case of the presence of SA infiltration, neoadjuvant treatment should be considered. SA infiltration might be reclassified from a T3 to T4 tumor.
脾脏血管侵犯（即 T3 肿瘤）在胰体尾导管腺癌（PDA）切除术后的预后价值尚未得到广泛研究。本研究旨在评估胰体尾 PDA 的预后因素，重点强调脾脏血管浸润的作用。
1990 年至 2008 年间，对 87 例经组织学证实的胰体尾 PDA 患者行远端胰腺切除术（DP），分析了与生存相关的临床病理预后因素。进行了单因素和多因素分析。
术后发病率为 31%，无死亡。1、3 和 5 年总生存率分别为 77%、48%和 24.5%。19 例（22%）患者存在脾动脉（SA）侵犯。与无 SA 侵犯的患者相比，SA 侵犯的患者预后明显较差（中位生存：15 个月与 39 个月，P = 0.014）。多因素分析显示，辅助治疗、低分化（G3/G4）、R2 切除、淋巴结转移和 SA 侵犯是生存的独立预测因素。
除其他公认的预后因素外，SA 侵犯是胰体尾 PDA 生存不良的独立预测因素。在存在 SA 浸润的情况下，应考虑新辅助治疗。SA 浸润可能会从 T3 肿瘤重新分类为 T4 肿瘤。
