新世纪的胰腺癌手术：更好的预后预测。

Pancreatic cancer surgery in the new millennium: better prediction of outcome.

机构信息

Department of General Surgery, University of Heidelberg, Germany.

出版信息

Ann Surg. 2011 Aug;254(2):311-9. doi: 10.1097/SLA.0b013e31821fd334.

DOI:10.1097/SLA.0b013e31821fd334

PMID:21606835

Abstract

BACKGROUND

Surgery is the only therapy with potentially curative intention in pancreatic cancer. This analysis aimed to determine prognostic parameters in a patient cohort with resected pancreatic adenocarcinoma with a special focus on the revised R1-definition.

METHODS

Between October 2001 and August 2009, data from 1071 consecutively resected patients with pancreatic adenocarcinoma were prospectively collected in an electronical database. Parameters tested for survival prediction in univariate analysis included patient, tumor, and resection characteristics as well as adjuvant therapy. The parameters with significant results were used for multivariate survival analysis. Identified parameters with positive or negative prognostic effect were used to define risk groups and to assess the effects on patient survival.

RESULTS

Age, ASA-score, CEA and CA19-9 levels, preoperative insulin-dependent diabetes mellitus, T-, N-, M-, R-, G-tumor classification, advanced disease, and LNR were all significant in univariate analysis, whereas gender, NYHA score, BMI, insurance status, type of surgical procedure, and adjuvant therapy were not. In multivariate analysis, age ≥70 years, preoperative insulin-dependent diabetes, CA19-9 ≥400 U/mL, T4-, M1- or G3-status, and LNR > 0.2 were independent negative predictors, whereas Tis/T1/T2-status, G1-differentiation, and R0-status (revised definition) were independently associated with good prognosis. Using these risk factors, patients were stratified into 4 risk-groups with significantly different prognosis; 5-year survival varied between 0% and 54.5%. Risk stratification resulted in improved survival prognostication within the predominant AJCC IIA and AJCC IIB stages.

CONCLUSIONS

A newly defined prognostic profiling including the revised R1-definition discriminates survival of patients with resectable pancreatic adenocarcinoma better than the AJCC staging system, and may be of particular relevance for patient-adjusted therapy in the heterogeneous group of AJCC stage II tumors.

摘要

背景

手术是胰腺癌唯一具有潜在治愈意图的治疗方法。本分析旨在确定接受根治性切除术的胰腺腺癌患者队列中的预后参数，特别关注修订后的 R1 定义。

方法

在 2001 年 10 月至 2009 年 8 月期间，前瞻性地在电子数据库中收集了 1071 例连续接受胰腺腺癌切除术的患者数据。在单因素分析中测试用于生存预测的参数包括患者、肿瘤和切除术特征以及辅助治疗。具有显著结果的参数用于多因素生存分析。确定具有阳性或阴性预后影响的参数用于定义风险组并评估对患者生存的影响。

结果

年龄、ASA 评分、CEA 和 CA19-9 水平、术前依赖胰岛素的糖尿病、T、N、M、R、G-肿瘤分类、晚期疾病和 LNR 在单因素分析中均有显著意义，而性别、NYHA 评分、BMI、保险状况、手术类型和辅助治疗则没有。在多因素分析中，年龄≥70 岁、术前依赖胰岛素的糖尿病、CA19-9≥400 U/mL、T4、M1 或 G3 状态和 LNR>0.2 是独立的负预测因素，而Tis/T1/T2 状态、G1 分化和 R0 状态（修订定义）与良好的预后相关。使用这些危险因素，患者被分为 4 个风险组，具有明显不同的预后；5 年生存率在 0%到 54.5%之间。风险分层在主要的 AJCC IIA 和 AJCC IIB 分期内改善了生存预后的预测。