Mierke Franz, Hempel Sebastian, Distler Marius, Aust Daniela E, Saeger Hans-Detlev, Weitz Jürgen, Welsch Thilo
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
Institute for Pathology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
Ann Surg Oncol. 2016 Dec;23(Suppl 5):730-736. doi: 10.1245/s10434-016-5515-6. Epub 2016 Aug 23.
The present study aims to evaluate the long-term outcome and metastatic pattern of patients who underwent resection of a pancreatic ductal adenocarcinoma (PDAC) with portal or superior mesenteric vein (PV/SMV) resection.
Patients who underwent a partial pancreatoduodenectomy or total pancreatectomy for PDAC between 2005 and 2015 were retrospectively analyzed. Three subgroups were generated, depending on PV/SMV resection (P) and pathohistological PV/SMV tumor infiltration (I): PI, PI, and PI. Statistical analysis was performed using the R software package.
The study cohort included 179 patients, 113 of whom underwent simultaneous PV/SMV resection. Thirty-six patients (31.9 %) had pathohistological tumor infiltration of the PV/SMV (PI), and were matched with 66 cases without PV/SMV infiltration (PI). The study revealed differences in overall median survival (11.9 [PI] vs. 16.1 [PI] vs. 20.1 [PI] months; p = 0.01). Multivariate survival analysis identified true invasion of the PV/SMV as the only significant, negative prognostic factor (p = 0.01). Whereas the incidence of local recurrence was comparable (p = 0.96), the proportion of patients with distant metastasis showed significant differences (75 % [PI] vs. 45.8 % [PI] vs. 54.7 % [PI], p = 0.01). Furthermore, the median time to progression was significantly shorter if the PV/SMV was involved (7.4 months [PI] vs. 10.9 months [PI] vs. 11.6 months [PI]). Initial liver metastases occurred in 33 % of the patients.
True invasion of the PV/SMV is an independent risk factor for overall survival, and is associated with a higher incidence of distant metastasis and shorter progressive-free survival. Radical vascular resection cannot compensate for aggressive tumor biology.
本研究旨在评估接受门静脉或肠系膜上静脉（PV/SMV）切除的胰腺导管腺癌（PDAC）患者的长期预后和转移模式。
对2005年至2015年间因PDAC接受部分胰十二指肠切除术或全胰切除术的患者进行回顾性分析。根据PV/SMV切除情况（P）和病理组织学PV/SMV肿瘤浸润情况（I）分为三个亚组：PI、PI和PI。使用R软件包进行统计分析。
研究队列包括179例患者，其中113例同时接受了PV/SMV切除。36例患者（31.9%）有PV/SMV的病理组织学肿瘤浸润（PI），与66例无PV/SMV浸润的病例（PI）匹配。研究显示总中位生存期存在差异（11.9[PI]对16.1[PI]对20.1[PI]个月；p=0.01）。多因素生存分析确定PV/SMV的真正侵犯是唯一显著的负性预后因素（p=0.01）。虽然局部复发率相当（p=0.96），但远处转移患者的比例存在显著差异（75%[PI]对45.8%[PI]对54.7%[PI]，p=0.01）。此外，如果PV/SMV受累，疾病进展的中位时间明显缩短（7.4个月[PI]对10.9个月[PI]对11.6个月[PI]）。33%的患者出现初始肝转移。
PV/SMV的真正侵犯是总生存的独立危险因素，与远处转移的较高发生率和较短的无进展生存期相关。根治性血管切除不能弥补侵袭性肿瘤生物学行为。
