Poruk Katherine E, Kim Yuhree, Cameron John L, He Jin, Eckhauser Frederic E, Rezaee Neda, Herman Joseph, Laheru Daniel, Zheng Lei, Fishman Elliot K, Hruban Ralph H, Pawlik Timothy M, Wolfgang Christopher L, Weiss Matthew J
Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Halsted 608, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
J Gastrointest Surg. 2015 May;19(5):841-7. doi: 10.1007/s11605-014-2740-9. Epub 2015 Jan 17.
The significance of indeterminate pulmonary nodules (IPNs) in patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) is unknown. We sought to define the prevalence and impact of IPN in such patients.
We studied all patients who underwent surgical resection of PDAC between 1980 and 2013. IPN was defined as ≥1 well-defined lung nodule(s) less than 3 cm in diameter. Survival was assessed using univariate and multivariate Cox models.
Of the 2306 resected patients, 374 (16.2 %) had a preoperative chest computed tomography (CT) scan. Of these patients, 183 (49 %) had ≥1 IPN. Demographic and clinicopathological characteristics were similar among patients with or without IPN (all P>0.05). Median survival was comparable among patients who did (15.6 months) or did not (18.0 months) have IPN (P=0.66). Of the 183 patients with IPN, 29 (16 %) progressed to clinically recognizable metastatic lung disease compared to 13 % without IPN (P=0.38). The presence of >1 IPN was associated with the development of lung metastasis (relative risk 1.58, 95 % CI 1.03-2.4; P=0.05). However, lung metastasis was not associated with survival (P=0.24).
An IPN proved to be a lung metastasis in only one of six patients with PDAC undergoing surgical resection in this study. Survival was not impacted, even among patients who developed lung metastasis. Patients with PDAC who have IPN should not be precluded from surgical consideration.
在接受胰腺导管腺癌（PDAC）切除术的患者中，不确定肺结节（IPN）的意义尚不清楚。我们试图明确此类患者中IPN的患病率及其影响。
我们研究了1980年至2013年间所有接受PDAC手术切除的患者。IPN定义为直径小于3 cm的≥1个边界清晰的肺结节。使用单因素和多因素Cox模型评估生存率。
在2306例接受手术切除的患者中，374例（16.2%）术前行胸部计算机断层扫描（CT）。在这些患者中，183例（49%）有≥1个IPN。有或无IPN的患者在人口统计学和临床病理特征方面相似（所有P>0.05）。有IPN的患者（15.6个月）和无IPN的患者（18.0个月）的中位生存期相当（P=0.66）。在183例有IPN的患者中，29例（16%）进展为临床可识别的肺转移瘤，而无IPN的患者为13%（P=0.38）。>1个IPN的存在与肺转移的发生相关（相对风险1.58，95%CI 1.03 - 2.4；P=0.05）。然而，肺转移与生存率无关（P=0.24）。
在本研究中，接受手术切除的PDAC患者中，每6例有IPN的患者中只有1例的IPN被证实为肺转移。即使是发生肺转移的患者，生存率也未受影响。有IPN的PDAC患者不应被排除在手术考虑之外。
