Takahashi Hidenori, Akita Hirofumi, Gotoh Kunihito, Kobayashi Shogo, Marubashi Shigeru, Miyoshi Norikatsu, Sugimura Keijiro, Motoori Masaaki, Kishi Kentaro, Noura Shingo, Fujiwara Yoshiyuki, Ohue Masayuki, Ohigashi Hiroaki, Yano Masahiko, Sakon Masato, Ishikawa Osamu
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan.
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan.
Surgery. 2015 Mar;157(3):484-95. doi: 10.1016/j.surg.2014.09.022. Epub 2014 Oct 16.
Among the various multimodal treatment strategies for pancreatic ductal adenocarcinoma (PDA), preoperative chemoradiation therapy (CRT) and subsequent operation is a promising strategy. The aim of this study is to evaluate the outcome of preoperative gemcitabine-based CRT for PDA of the body and tail, focusing on the associations among splenic vessel involvement, surgical outcomes, and pattern of recurrence.
A total of 99 patients with PDA of the body and tail received preoperative CRT. The status of tumor involvement of the splenic artery (SA) and vein (SV) were evaluated based on radiographical findings obtained before the initiation of preoperative CRT. We assessed the following in association with the status of SA and SV involvement: (1) resection rate, (2) survival, and (3) pattern of recurrence.
The resection rate of SA-positive cases (71%) was significantly lesser than that of SA-negative cases (94%; P = .004), whereas SV involvement was not associated with the resection rate. The 5-year survival rates of the resected SA-negative and SA-positive cases were 76% and 20%, respectively (P < .001). The 5-year cumulative incidence of distant recurrence was significantly higher in the SA-positive patients than in the SA-negative patients (74% vs. 17%; P < .001).
In preoperative CRT for PDA of the body and tail, positive SA involvement was associated with a lesser resection rate, and the survival rate for the patients with SA-positive tumors was lesser than that for patients with SA-negative tumors because of the greater incidence of distant recurrence in SA-positive patients.
在胰腺导管腺癌（PDA）的多种多模式治疗策略中，术前放化疗（CRT）及后续手术是一种有前景的策略。本研究的目的是评估以吉西他滨为基础的术前CRT治疗体尾部PDA的疗效，重点关注脾血管受累、手术结果和复发模式之间的关联。
共有99例体尾部PDA患者接受了术前CRT。根据术前CRT开始前获得的影像学检查结果评估脾动脉（SA）和静脉（SV）的肿瘤受累情况。我们结合SA和SV受累情况评估了以下内容：（1）切除率，（2）生存率，（3）复发模式。
SA阳性病例的切除率（71%）显著低于SA阴性病例（94%；P = 0.004），而SV受累与切除率无关。切除的SA阴性和SA阳性病例的5年生存率分别为76%和20%（P < 0.001）。SA阳性患者的远处复发5年累积发生率显著高于SA阴性患者（74%对17%；P < 0.001）。
在体尾部PDA的术前CRT中，SA受累阳性与较低的切除率相关，SA阳性肿瘤患者的生存率低于SA阴性肿瘤患者，因为SA阳性患者远处复发的发生率更高。
