Picozzi Vincent J, Oh Stephen Y, Edwards Alicia, Mandelson Margaret T, Dorer Russell, Rocha Flavio G, Alseidi Adnan, Biehl Thomas, Traverso L William, Helton William S, Kozarek Richard A
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Cancer Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Ann Surg Oncol. 2017 Jun;24(6):1722-1730. doi: 10.1245/s10434-016-5716-z. Epub 2017 Jan 4.
Successful surgical resection combined with effective perioperative therapy is essential for maximizing long-term survival for pancreatic adenocarcinoma.
All patients with pancreatic adenocarcinoma who underwent curative resection at our institution from January 2003 to May 2010 were reviewed. Demographic and clinical details were retrospectively collected from medical records and cancer registry data.
Overall, 176 patients were included in the analysis (148 with de novo resectable disease and 28 with borderline resectable disease at presentation). Among 106 patients who received all perioperative therapy at our institution, 94% received neoadjuvant and/or adjuvant treatment in addition to resection. Actual all-cause 5-year overall survival (OS) for all 176 patients was 30.7%, with a median OS of 33.9 months [95% confidence interval (CI) 28.1-39.6 months]. For patients who received all perioperative therapy at our institution, actual all-cause 5-year disease-free survival (DFS) was 32.1%, with a median DFS of 28.8 months (95% CI 20.1-43.6 months). Of these patients, 67/106 (63%) recurred: 8 (8%) locoregional only; 52 (49%) systemic only; and 7 (7%) combined recurrence. No difference in survival rates or recurrence patterns was seen between resectable and borderline resectable patients. In multivariate analysis, tumor differentiation (poor vs. non-poor) and lymph node ratio >20% produced a useful clinical model.
The actual OS rates for resected pancreatic cancer shown in this study are reflective of those currently achievable at a tertiary medical center dedicated to this patient population. In considering these results, both frequency and type of adjuvant/neoadjuvant therapy administered in the context of the clinical experience/management techniques of providers administering these treatments will be discussed.
成功的手术切除联合有效的围手术期治疗对于使胰腺腺癌患者的长期生存率最大化至关重要。
回顾了2003年1月至2010年5月期间在本机构接受根治性切除的所有胰腺腺癌患者。从病历和癌症登记数据中回顾性收集人口统计学和临床细节。
总体而言，176例患者纳入分析（148例初诊时为可切除疾病，28例为临界可切除疾病）。在本机构接受所有围手术期治疗的106例患者中，94%除手术外还接受了新辅助和/或辅助治疗。176例患者的实际全因5年总生存率（OS）为30.7%，中位OS为33.9个月[95%置信区间（CI）28.1 - 39.6个月]。在本机构接受所有围手术期治疗的患者中，实际全因5年无病生存率（DFS）为32.1%，中位DFS为28.8个月（95% CI 20.1 - 43.6个月）。这些患者中，67/106（63%）复发：仅局部区域复发8例（8%）；仅远处转移52例（49%）；联合复发7例（7%）。可切除和临界可切除患者的生存率或复发模式无差异。多因素分析显示，肿瘤分化（差与非差）和淋巴结转移率>20%可构建有效的临床模型。
本研究中显示的切除胰腺癌的实际OS率反映了目前在致力于该患者群体的三级医疗中心所能达到的水平。在考虑这些结果时，将讨论在实施这些治疗的医疗人员的临床经验/管理技术背景下给予辅助/新辅助治疗的频率和类型。
