Satoi Sohei, Murakami Yoshiaki, Motoi Fuyuhiko, Uemura Kenichiro, Kawai Manabu, Kurata Masanao, Sho Masayuki, Matsumoto Ippei, Yanagimoto Hiroaki, Yamamoto Tomohisa, Mizuma Masamichi, Unno Michiaki, Hashimoto Yasushi, Hirono Seiko, Yamaue Hiroki, Honda Goro, Nagai Minako, Nakajima Yoshiyuki, Shinzeki Makoto, Fukumoto Takumi, Kwon A-Hon
Department of Surgery, Kansai Medical University, Osaka, Japan.
J Gastrointest Surg. 2015 Jan;19(1):6-14; discussion 14. doi: 10.1007/s11605-014-2637-7. Epub 2014 Oct 15.
The objective of the present study was to reappraise the clinical value of peritoneal washing cytology (CY) in 984 pancreatic ductal adenocarcinoma patients who underwent margin-negative resection.
In a 2001-2011 database from seven high-volume surgical institutions in Japan, 69 patients (7%) had positive CY (CY+ group) indicative of M1 disease and 915 patients had negative CY (CY- group). Clinicopathological data and survival were compared between groups.
Significant correlations between CY+ and high CA19-9 level, pancreatic body and tail cancer, lymph node metastasis, and a lower frequency of R0 resection were observed. Overall survival (OS) of CY+ patients was significantly worse than that of CY- patients (median survival time [MST], 16 vs. 25 months; 3-year OS rate, 6 vs. 37%; p < 0.001). CY+ patients had a significantly higher rate of post-operative peritoneal carcinomatosis than CY- patients (48 vs. 21%; p < 0.001). Administration of adjuvant chemotherapy did not provide a favorable survival outcome to CY+ patients. The current study showed that patients with M1 disease had acceptable MST after margin-negative resection and a high incidence of peritoneal carcinomatosis within 3 years after surgery, resulting in decreased long-term survival. The development of a new strategy to control peritoneal carcinomatosis when surgical resection is performed in such patients is required.
本研究旨在重新评估984例接受切缘阴性切除术的胰腺导管腺癌患者的腹腔冲洗细胞学检查（CY）的临床价值。
在日本7家大型外科机构2001年至2011年的数据库中，69例患者（7%）CY检查呈阳性（CY+组），提示存在M1期疾病，915例患者CY检查呈阴性（CY-组）。比较两组的临床病理数据和生存率。
观察到CY+与高CA19-9水平、胰体尾癌、淋巴结转移以及R0切除频率较低之间存在显著相关性。CY+患者的总生存期（OS）明显差于CY-患者（中位生存时间[MST]，16个月对25个月；3年OS率，6%对37%；p<0.001）。CY+患者术后腹膜癌转移率明显高于CY-患者（48%对21%；p<0.001）。辅助化疗并未给CY+患者带来良好的生存结局。本研究表明，M1期疾病患者在切缘阴性切除术后具有可接受的MST，但术后3年内腹膜癌转移发生率较高，导致长期生存率降低。对于此类患者在进行手术切除时，需要制定一种新的策略来控制腹膜癌转移。
