Cloyd Jordan M, Wang Huamin, Overman Michael, Zhao Jun, Denbo Jason, Prakash Laura, Kim Michael P, Shroff Rachna, Javle Milind, Varadhachary Gauri R, Fogelman David, Wolff Robert A, Koay Eugene J, Das Prajnan, Maitra Anirban, Aloia Thomas A, Vauthey Jean-Nicolas, Fleming Jason B, Lee Jeffrey E, Katz Matthew H G
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2017 Jul;24(7):2031-2039. doi: 10.1245/s10434-017-5777-7. Epub 2017 Jan 25.
Although preoperative therapy is increasingly administered to patients with pancreatic adenocarcinoma, the role of preoperative therapy for patients with adenocarcinoma of the ampulla of Vater is undefined.
All patients with ampullary cancer who were evaluated between 1999 and 2014 were retrospectively reviewed. Differences in clinicopathologic characteristics, perioperative complications, and overall survival were compared between patients who underwent surgery de novo and those who received preoperative therapy before pancreatoduodenectomy.
A total of 142 patients underwent pancreatoduodenectomy: 43 (30.3%) who received preoperative therapy and 99 (69.7%) who did not. Preoperative therapy consisted of chemoradiation (65%), chemotherapy (7%), or both (28%). Patients who underwent surgery first had a lower comorbidity index (p < 0.05) and were more likely to receive postoperative chemotherapy (p < 0.01) and chemoradiation (p < 0.0001). Tumors resected de novo were larger (p < 0.01) and had a different histopathologic subtype distribution (p < 0.01) on final pathology than those resected following preoperative therapy. Six (14.0%) patients demonstrated a complete pathologic response. There were no differences in rates of postoperative complications, mortality, readmission, LR (9.1 vs. 7.0%), median survival (107 vs. 146 months), or 5-year overall survival (60.6 vs. 70.4%). On multivariate cox regression analysis, the receipt of preoperative therapy was not associated with improved survival (odds ratio 1.14, 95% confidence interval (CI) 0.56-2.31).
Although these data do not support the routine administration of preoperative therapy to all patients with ampullary cancer, the delivery of preoperative therapy represents an alternative strategy that is associated with excellent short- and long-term outcomes and appears appropriate for a subset of patients.
尽管术前治疗越来越多地应用于胰腺腺癌患者，但术前治疗对壶腹腺癌患者的作用尚不明确。
回顾性分析1999年至2014年间所有接受评估的壶腹癌患者。比较直接接受手术的患者与在胰十二指肠切除术前行术前治疗的患者在临床病理特征、围手术期并发症及总生存期方面的差异。
共有142例患者接受了胰十二指肠切除术：43例（30.3%）接受了术前治疗，99例（69.7%）未接受术前治疗。术前治疗包括放化疗（65%）、化疗（7%）或两者联合（28%）。直接接受手术的患者合并症指数较低（p<0.05），更有可能接受术后化疗（p<0.01）和放化疗（p<0.0001）。与术前治疗后切除的肿瘤相比，直接切除的肿瘤更大（p<0.01），最终病理检查时组织病理学亚型分布不同（p<0.01）。6例（14.0%）患者表现出完全病理缓解。术后并发症发生率、死亡率、再入院率、局部复发率（9.1%对7.0%）、中位生存期（107个月对146个月）或5年总生存率（60.6%对70.4%）无差异。多因素cox回归分析显示，接受术前治疗与生存期改善无关（比值比1.14，95%置信区间（CI）0.56 - 2.31）。
尽管这些数据不支持对所有壶腹癌患者常规进行术前治疗，但术前治疗是一种替代策略，与良好的短期和长期预后相关，似乎适用于一部分患者。
