Ansari Daniel, Kervinen Miikka, Andersson Roland
Hepatogastroenterology. 2014 Nov-Dec;61(136):2387-90.
Pancreatic cancer is a challenging disease due to the low resection rate at the time of initial diagnosis. A relatively new classification of marginally resectable pancreatic cancer has emerged and there is some evidence that this subgroup of patients may benefit from neoadjuvant radiochemotherapy. The first major definition of marginally resectable pancreatic cancer was made at M. D. Anderson Cancer Center and published in 2006. This definition was purely anatomical and CT-based and only handles the relationship of the pancreatic, tumor to its surrounding major vessels. Later on, two other subtypes have been added to this definition: suspicion or known metastasis in regional lymph nodes (N1 disease), or severe pre-existing medical comorbidities requiring prolonged evaluation or recovery and precluding immediate surgery. Other definitions (anatomical and CT-based) for marginally resectable pancreatic cancer have also been established. For systematic research on neoadjuvant therapy in marginally resectable pancreatic cancer, however, the lack of uniform definitions and randomized trials have been troublesome. Nevertheless, several small cohort studies have demonstrated that 40-80% of the marginally resectable patients could proceed to resection after neoadjuvant treatment and also reporting some promising effects on microscopic resection margins, lymph node status and survival.
由于胰腺癌在初次诊断时的低切除率，它是一种具有挑战性的疾病。一种相对较新的边缘可切除胰腺癌分类已经出现，并且有一些证据表明这类患者亚组可能从新辅助放化疗中获益。边缘可切除胰腺癌的首个主要定义由MD安德森癌症中心制定并于2006年发表。该定义完全基于解剖学和CT，仅涉及胰腺肿瘤与其周围主要血管的关系。后来，该定义又增加了另外两种亚型：区域淋巴结可疑或已知转移（N1期疾病），或存在严重的基础疾病合并症，需要长时间评估或恢复且无法立即进行手术。也已经建立了其他边缘可切除胰腺癌的定义（基于解剖学和CT）。然而，对于边缘可切除胰腺癌新辅助治疗的系统研究，缺乏统一的定义和随机试验一直是个难题。尽管如此，几项小型队列研究表明，40%至80%的边缘可切除患者在新辅助治疗后能够进行手术切除，并且在微观切缘、淋巴结状态和生存率方面也报告了一些有前景的效果。
