Matsumoto Ippei, Murakami Yoshiaki, Shinzeki Makoto, Asari Sadaki, Goto Tadahiro, Tani Masaji, Motoi Fuyuhiko, Uemura Kenichiro, Sho Masayuki, Satoi Sohei, Honda Goro, Yamaue Hiroki, Unno Michiaki, Akahori Takahiro, Kwon A-Hon, Kurata Masanao, Ajiki Tetsuo, Fukumoto Takumi, Ku Yonson
Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Institute of Biomedical and Health Sciences, Department of Surgery, Hiroshima University, Hiroshima, Japan.
Pancreatology. 2015 Nov-Dec;15(6):674-80. doi: 10.1016/j.pan.2015.09.008. Epub 2015 Oct 3.
BACKGROUND/OBJECTIVE: Although surgical resection remains the only chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC), postoperative early recurrence (ER) is frequently encountered. The purpose of this study is to determine the preoperative predictive factors for ER after upfront surgical resection.
Between 2001 and 2012, 968 patients who underwent upfront surgery with R0 or R1 resection for PDAC at seven high-volume centers in Japan were retrospectively reviewed. ER was defined as relapse within 6 months after surgery. Study analysis stratified by resectable (R) and borderline resectable (BR) PDACs was conducted according to the National Comprehensive Cancer Network guidelines.
ER occurred in 239 patients (25%) with a median survival time (MST) of 8.8 months. Modified Glasgow prognostic score = 2 (odds ratio (OR) 2.06, 95% confidence interval (CI) 1.05-3.95; P = 0.044), preoperative CA19-9 ≥300 U/ml (OR 1.94, 1.29-2.90; P = 0.003), and tumor size ≥30 mm (OR 1.72, 1.16-2.56; P = 0.006), were identified as preoperative independent predictive risk factors for ER in patients with R-PDAC. In the R-PDAC patients, MST was 35.5, 26.3, and 15.9 months in patients with 0, 1 and ≥2 risk factors, respectively. There were significant differences in overall survival between the three groups (P < 0.001). No preoperative risk factors were identified in BR-PDAC patients with a high rate of ER (39%).
There is a high-risk subset for ER even in patients with R-PDAC and a simple risk scoring system is useful for prediction of ER.
背景/目的：尽管手术切除仍是胰腺导管腺癌（PDAC）患者唯一的治愈机会，但术后早期复发（ER）却屡见不鲜。本研究旨在确定 upfront 手术切除术后 ER 的术前预测因素。
回顾性分析 2001 年至 2012 年期间在日本七个高容量中心接受 upfront 手术且 R0 或 R1 切除的 968 例 PDAC 患者。ER 定义为术后 6 个月内复发。根据美国国立综合癌症网络指南，对可切除（R）和边界可切除（BR）的 PDAC 进行分层研究分析。
239 例患者（25%）发生 ER，中位生存时间（MST）为 8.8 个月。改良格拉斯哥预后评分=2（比值比（OR）2.06，95%置信区间（CI）1.05 - 3.95；P = 0.044）、术前 CA19 - 9≥300 U/ml（OR 1.94，1.29 - 2.90；P = 0.003）以及肿瘤大小≥30 mm（OR 1.72，1.16 - 2.56；P = 0.006），被确定为 R - PDAC 患者 ER 的术前独立预测风险因素。在 R - PDAC 患者中，0、1 和≥2 个风险因素的患者 MST 分别为 35.5、26.3 和 15.9 个月。三组之间的总生存期存在显著差异（P < 0.001）。BR - PDAC 患者 ER 发生率高（39%），未发现术前风险因素。
即使是 R - PDAC 患者也存在 ER 的高危亚组，简单的风险评分系统有助于预测 ER。
