Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA.
Gut. 2015 Jul;64(7):1105-10. doi: 10.1136/gutjnl-2014-307475. Epub 2015 Jan 9.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) allows preoperative tissue confirmation of malignancy, but fear of tumour cell dissemination along the needle track has limited its use. We hypothesised that if tumour cell dissemination occurs with EUS-FNA, survival after complete resection would be impaired. We aimed to evaluate the association of preoperative EUS-FNA with long-term outcomes of patients with resected pancreatic cancer.
Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients with locoregional pancreatic cancer who underwent curative intent surgery from 1998 to 2009. The patients who received EUS-FNA within the peridiagnostic period were included in the EUS-FNA group. Patients who did not receive EUS evaluation or who underwent EUS without FNA were included in the non-EUS-FNA group. Overall survival and pancreatic cancer-specific survival were compared after controlling for relevant covariates.
A total of 2034 patients with pancreatic cancer were included (90% pancreatic adenocarcinoma). Of these, 498 (24%) patients were in EUS-FNA group. Patients with multiple comorbidities and more recent diagnosis were more likely to receive EUS-FNA. In multivariate analysis, after controlling for age, race, gender, tumour histology, tumour stage, tumour grade, tumour location, SEER site, year of diagnosis, undergoing percutaneous aspiration/biopsy, Charlson Comorbidity Index, radiation and chemotherapy, EUS-FNA was marginally associated with improved overall survival (HR 0.84, 95% CI 0.72 to 0.99), but did not affect cancer-specific survival (HR 0.87, 95% CI 0.74 to 1.03).
Preoperative EUS-FNA was not associated with increased risk of mortality. These data suggest that EUS-FNA can be safely performed for the work-up of suspicious pancreatic lesions.
内镜超声引导下细针抽吸术（EUS-FNA）可在术前对恶性肿瘤进行组织确认，但由于担心肿瘤细胞沿针道扩散，其应用受到限制。我们假设如果 EUS-FNA 确实导致肿瘤细胞扩散，那么完全切除后的生存情况将会受到影响。本研究旨在评估术前 EUS-FNA 与接受根治性手术治疗的胰腺腺癌患者长期预后之间的相关性。
利用 SEER 数据库和 Medicare 数据进行链接，我们确定了 1998 年至 2009 年间接受根治性手术治疗的局限性局部胰腺癌症患者。在诊断前期间接受 EUS-FNA 的患者被纳入 EUS-FNA 组。未接受 EUS 评估或仅接受 EUS 而未行 FNA 的患者被纳入非 EUS-FNA 组。在控制相关协变量后，比较两组患者的总生存和胰腺癌症特异性生存情况。
共纳入 2034 例胰腺癌症患者（90%为胰腺腺癌）。其中 498 例（24%）患者接受了 EUS-FNA 检查。患有多种合并症和近期诊断的患者更有可能接受 EUS-FNA 检查。多变量分析显示，在控制年龄、种族、性别、肿瘤组织学、肿瘤分期、肿瘤分级、肿瘤位置、SEER 部位、诊断年份、经皮抽吸/活检、Charlson 合并症指数、放疗和化疗后，EUS-FNA 与改善的总生存情况呈显著相关（HR 0.84，95%CI 0.72 至 0.99），但不影响癌症特异性生存情况（HR 0.87，95%CI 0.74 至 1.03）。
术前 EUS-FNA 与死亡率增加无关。这些数据表明，EUS-FNA 可安全用于可疑胰腺病变的检查。
