Harvard Medical School, Boston, Massachusetts.
Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
Pract Radiat Oncol. 2012 Oct-Dec;2(4):e89-e94. doi: 10.1016/j.prro.2012.02.004. Epub 2012 Mar 31.
To determine the prevalence and significance of incidental, subcentimeter hepatic lesions in patients with a new diagnosis of pancreatic cancer.
This Institutional Review Board-approved retrospective study included 101 patients [45% men, median age 63 years (34-85)] treated for localized pancreatic adenocarcinoma at Brigham and Women's Hospital and Dana Farber Cancer Institute from January 1999 to December 2007. Initial staging and follow-up computed tomographic scans were reviewed to determine the frequency of liver lesions that were initially too small to characterize and later proved to be metastases. Clinical variables known to be prognostic for patients with pancreatic cancer were also recorded. Using Cox regression, we calculated adjusted hazard ratios to determine the association between presence of liver lesions and overall survival.
A total of 31 patients (30.7%) had subcentimeter hepatic lesions on staging scans. Of these patients, 21 (20.7% of total, 67.7% of patients with lesions) had eventual metastases to the liver. Finally, of this group, 5 patients (5.0% of total, 16.1% of patients with lesions) eventually had a metastatic focus at the specific site of the original lesion. Liver lesions predicted the occurrence of metastatic disease to the liver compared with patients without lesions (67.7% with lesions vs 44.4% without, P = .034). The presence of subcentimeter liver lesions at diagnosis was significantly associated with reduced overall survival (hazard ratio 1.65; 95% confidence interval 1.03-2.64, P = .036).
Subcentimeter lesions in the liver are common in patients with a new diagnosis of pancreatic cancer. Approximately 16% of these lesions represent metastases. The presence of indeterminate liver lesions may be associated with reduced overall survival.
确定新诊断为胰腺癌患者中偶然发现的、直径小于 1 厘米的肝病变的发生率和意义。
这项经过机构审查委员会批准的回顾性研究纳入了 101 例患者（45%为男性，中位年龄 63 岁[34-85 岁]），他们于 1999 年 1 月至 2007 年 12 月在布莱根妇女医院和达纳法伯癌症研究所接受了局部胰腺腺癌的治疗。回顾初始分期和随访 CT 扫描，以确定最初太小而无法定性但后来被证实为转移的肝病变的频率。还记录了已知与胰腺癌患者预后相关的临床变量。我们使用 Cox 回归计算调整后的危险比，以确定肝脏病变的存在与总生存率之间的关联。
共有 31 例患者（30.7%）在分期扫描中发现了小于 1 厘米的肝病变。这些患者中，有 21 例（20.7%的总数，有病变的患者中 67.7%）最终发生了肝转移。最终，在这一组中，有 5 例患者（5.0%的总数，有病变的患者中 16.1%）最终在原始病变的特定部位出现了转移灶。与无病变的患者相比，有肝病变的患者更有可能发生肝转移（有病变的患者为 67.7%，无病变的患者为 44.4%，P =.034）。在诊断时存在直径小于 1 厘米的肝病变与总生存率降低显著相关（危险比 1.65；95%置信区间 1.03-2.64，P =.036）。
新诊断为胰腺癌的患者中，肝脏的直径小于 1 厘米的病变很常见。这些病变中约有 16%代表转移。存在不确定的肝病变可能与总生存率降低有关。
