Murakami Yoshiaki, Satoi Sohei, Sho Masayuki, Motoi Fuyuhiko, Matsumoto Ippei, Kawai Manabu, Honda Goro, Uemura Kenichiro, Yanagimoto Hiroaki, Shinzeki Makoto, Kurata Masanao, Kinoshita Shoichi, Yamaue Hiroki, Unno Michiaki
Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan,
World J Surg. 2015 Sep;39(9):2306-14. doi: 10.1007/s00268-015-3096-3.
The aim of this study was to evaluate the validity of preoperative resectability status, as defined by the National Comprehensive Cancer Network (NCCN), from the viewpoint of overall survival.
A total of consecutive 704 patients with pancreatic head carcinoma who underwent pancreatoduodenectomy with upfront surgery at seven Japanese hospitals between 2001 and 2012 were evaluated retrospectively. According to the NCCN definition of preoperative resectability status, tumors were divided into resectable tumors without vascular contact (R group), resectable tumors with portal or superior mesenteric vein (PV/SMV) contact of ≦180° (R-PV group), borderline resectable(BR) tumors with PV/SMV contact of >180° (BR-PV group), and BR tumors with arterial contact (BR-A group). The relationship between the NCCN definition of preoperative resectability status and overall survival was analyzed.
Of the 704 patients, 389, 114, 145, and 56 were classified into the R group, the R-PV group, the BR-PV group, and the BR-A group, respectively. Overall survival of the BR-PV and BR-A groups was significantly worse than that of the R group and R-PV groups (P < 0.05), although there was no significant difference in overall survival between the R group and the R-PV group (P = 0.310). Multivariate analysis revealed that PV/SMV contact of >180° (P = 0.008) and arterial contact (P < 0.001) were independent prognostic factors of overall survival.
From the viewpoint of overall survival, the NCCN definition of preoperative resectability status was valid.
本研究旨在从总生存期的角度评估美国国立综合癌症网络（NCCN）所定义的术前可切除性状态的有效性。
对2001年至2012年间在日本七家医院接受一期胰十二指肠切除术的704例连续性胰头癌患者进行回顾性评估。根据NCCN术前可切除性状态的定义，肿瘤分为无血管侵犯的可切除肿瘤（R组）、门静脉或肠系膜上静脉（PV/SMV）侵犯角度≤180°的可切除肿瘤（R-PV组）、PV/SMV侵犯角度>180°的边缘可切除（BR）肿瘤（BR-PV组）以及有动脉侵犯的BR肿瘤（BR-A组）。分析NCCN术前可切除性状态定义与总生存期之间的关系。
704例患者中，分别有389例、114例、145例和56例被归入R组、R-PV组、BR-PV组和BR-A组。BR-PV组和BR-A组的总生存期显著低于R组和R-PV组（P<0.05），尽管R组和R-PV组的总生存期无显著差异（P=0.310）。多因素分析显示，PV/SMV侵犯角度>180°（P=0.008）和动脉侵犯（P<0.001）是总生存期的独立预后因素。
从总生存期的角度来看，NCCN术前可切除性状态的定义是有效的。
