Onoe Shunsuke, Kaneoka Yuji, Maeda Atsuyuki, Takayama Yuichi, Fukami Yasuyuki
Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan.
Langenbecks Arch Surg. 2017 May;402(3):439-446. doi: 10.1007/s00423-017-1562-0. Epub 2017 Mar 1.
Operative indications for pancreatic head adenocarcinoma (PHC) with vascular invasion remain unclear. We aimed to develop a new prognostic model focusing on preoperative portal/superior mesenteric vein (PV/SMV) and superior mesenteric artery (SMA) invasiveness.
From 2005 to 2012, 103 patients underwent pancreatoduodenectomy for PHC. The CT findings for both PV/SMV and SMA invasion were evaluated separately [PV/SMV, none (score 0), unilateral narrowing (score 1), bilateral narrowing/stenosis (score 2); SMA, none or <90° (score 0), ≥90° (score 3)]. The total score defined the preoperative vascular involvement score (VI score); VI scores 0 (n = 39), 1 (n = 32), 2 (n = 17) and ≥3 (n = 15) were compared.
PV/SMV resection was performed in 1 (3%), 29 (91%), 16 (94%) and 13 (87%) cases of VI scores 0, 1, 2 and ≥3, respectively (P < 0.001). No patients with VI scores ≥3 had margin-negative resection; pathologically curative resection was achieved in 37 of 39 (95%), 27 of 32 (84%) and 13 of 17 (76%) patients with VI scores of 0, 1 and 2, respectively (P < 0.001). The survival rate and median survival time (MST) were reduced with an increasing VI score (MST, 40.9, 16.5, 8.9 and 6.3 months, respectively). The comparison of each survival curve revealed significant differences (P < 0.005), except when comparing VI scores 1 and 2 (P = 0.134).
Higher VI score predicts shorter survival. Proposed scoring system may be useful for determining the choice between undergoing neoadjuvant treatment, or upfront resection with adjuvant treatment.
伴有血管侵犯的胰头腺癌（PHC）的手术指征仍不明确。我们旨在开发一种新的预后模型，重点关注术前门静脉/肠系膜上静脉（PV/SMV）和肠系膜上动脉（SMA）侵犯情况。
2005年至2012年，103例患者因PHC接受了胰十二指肠切除术。分别评估PV/SMV和SMA侵犯的CT表现[PV/SMV，无（评分0）、单侧狭窄（评分1）、双侧狭窄/狭窄（评分2）；SMA，无或<90°（评分0）、≥90°（评分3）]。总分定义为术前血管受累评分（VI评分）；比较VI评分0（n = 39）、1（n = 32）、2（n = 17）和≥3（n = 15）的情况。
VI评分0、1、2和≥3的病例中，分别有1例（3%）、29例（91%）、16例（94%）和13例（87%）进行了PV/SMV切除（P < 0.001）。VI评分≥3的患者均未实现切缘阴性切除；VI评分为0、l和2的患者中，分别有39例中的37例（95%）、32例中的27例（84%）和17例中的13例（76%）实现了病理治愈性切除（P < 0.001）。随着VI评分增加，生存率和中位生存时间（MST）降低（MST分别为40.9、16.5、8.9和6.3个月）。除比较VI评分1和2时（P = 0.134）外，各生存曲线比较显示差异有统计学意义（P < 0.005）。
较高的VI评分预示生存时间较短。所提出的评分系统可能有助于确定是接受新辅助治疗，还是先行手术切除并辅以辅助治疗。
