Suenaga Masaya, Fujii Tsutomu, Kanda Mitsuro, Takami Hideki, Okumura Norio, Inokawa Yoshikuni, Kobayashi Daisuke, Tanaka Chie, Yamada Suguru, Sugimoto Hiroyuki, Nomoto Shuji, Fujiwara Michitaka, Kodera Yasuhiro
Hepatogastroenterology. 2014 Sep;61(134):1756-61.
BACKGROUND/AIMS: The aim of this study was to evaluate patterns of the initial recurrence after pancreatectomy for pancreatic cancer and risk factors in each pattern.
This study included 209 pancreatic cancer patients who underwent pancreatectomy and of whom the detailed information on the first recurrent lesions detected by imaging during postoperative followup were available. Relapse patterns were classified into 4 groups: liver, peritoneal, local and extra-abdominal recurrences. We evaluated their associations with prognosis and various clinicopathological factors to identify relevant risk factors.
Cumulative numbers of patients with liver, peritoneal, local, and extra-abdominal recurrences were 81, 70, 98 and 22, respectively, for the first recurrences. Hepatic relapse was associated with significantly shorter overall survival than other sites (p<0.001) and was an independent prognostic factor in multivariate analysis (p<0.001). Pathological portal vein invasion was the only independent risk factor for hepatic relapse (p=0.045). There was no significant correlation between the depth of invasion and prevalence of hepatic relapse.
Hepatic relapse was associated with a dismal prognosis and with pathological portal vein invasion. Novel therapeutic strategies are therefore required to reduce the incidence of hepatic relapse, especially in patients with portal vein invasion.
背景/目的：本研究旨在评估胰腺癌胰十二指肠切除术后的首次复发模式及每种模式下的危险因素。
本研究纳入了209例行胰十二指肠切除术的胰腺癌患者，这些患者术后随访期间通过影像学检查发现了首次复发病变的详细信息。复发模式分为4组：肝转移、腹膜转移、局部复发和腹外复发。我们评估了它们与预后及各种临床病理因素的相关性，以确定相关危险因素。
首次复发时，肝转移、腹膜转移、局部复发和腹外复发的累积患者数分别为81例、70例、98例和22例。肝转移患者的总生存期显著短于其他部位转移患者（p<0.001），多因素分析显示肝转移是独立的预后因素（p<0.001）。病理门静脉侵犯是肝转移的唯一独立危险因素（p=0.045）。侵犯深度与肝转移发生率之间无显著相关性。
肝转移与预后不良及病理门静脉侵犯相关。因此，需要新的治疗策略来降低肝转移的发生率，尤其是门静脉侵犯患者。
