Elmi Azadeh, Murphy Janet, Hedgire Sandeep, McDermott Shaunagh, Abtahi Seyed-Mahdi, Halpern Elkan, Fernandez-Del Castillo Carlos, Harisinghani Mukesh
Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA, 02114, USA.
Division of Hematology and Oncology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
Abdom Radiol (NY). 2017 Aug;42(8):2101-2107. doi: 10.1007/s00261-017-1099-2.
To compare the survival outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) who had regular imaging surveillance with those who had clinical follow-up after Whipple.
We identified 229 patients, who underwent Whipple for resection of PDAC from 2005 to 2011, and had regular postoperative clinical follow-up at our hospital. Patients were retrospectively selected for two follow-up groups: imaging surveillance (IS) defined as routine imaging at scheduled intervals, vs. clinical (C) defined as imaging triggered by either change in clinical status or change in CA19-9. Follow-up was obtained through the hospital and Cancer Data Registry records. Survival was calculated from the date of surgery to death or last follow-up, with data censored as of March 13, 2013. Kaplan-Meier survival curves were compared using the log-rank test, and Cox regression models were used for multivariate analysis.
Patients were followed for a mean period of 24.35 ± 2.56 months. IS-group underwent significantly more imaging (4.41 vs. 2.08 scans/year). The most frequent imaging was CT of chest and abdomen at 3-4 month interval. Univariate associations with overall survival were detected with post-Whipple ECOG status, T-stage, N-stage, tumor grade, surgical margin, recurrence, and IS. In multivariate analysis, grade, ECOG status, and recurrence were independent predictors of survival. Also, our predictor of interest, IS, was highly associated with longer survival in multivariate modeling (median overall survival, 30.4±3.85 (IS-group) vs. 17.1 ± 2.42 (C-groups) month, log-rank p = 0.002).
Routine imaging surveillance was associated with prolonged overall survival post-Whipple in a multivariate model. This is a hypothesis-generating finding that should be studied prospectively and could ultimately impact surveillance guidelines.
比较接受胰十二指肠切除术的胰腺导管腺癌（PDAC）患者中，进行定期影像监测与临床随访者的生存结局。
我们纳入了2005年至2011年间接受胰十二指肠切除术以切除PDAC且在我院进行定期术后临床随访的229例患者。患者被回顾性分为两个随访组：影像监测（IS）组，即按预定间隔进行常规影像检查；临床随访（C）组，即根据临床状态变化或CA19-9变化触发影像检查。通过医院记录和癌症数据登记处获取随访信息。从手术日期计算至死亡或最后一次随访的生存时间，数据截至2013年3月13日进行截尾。采用对数秩检验比较Kaplan-Meier生存曲线，并使用Cox回归模型进行多因素分析。
患者的平均随访时间为24.35±2.56个月。IS组进行的影像检查显著更多（4.41次/年 vs. 2.08次/年）。最常见的影像检查是每隔3 - 4个月进行一次胸部和腹部CT检查。与总生存相关的单因素分析包括胰十二指肠切除术后的美国东部肿瘤协作组（ECOG）状态、T分期、N分期、肿瘤分级、手术切缘、复发情况以及影像监测。多因素分析中，分级、ECOG状态和复发是生存的独立预测因素。此外，我们感兴趣的预测因素影像监测，在多因素模型中与更长的生存高度相关（总生存中位数，IS组为30.4±3.85个月，C组为月17.1±2.42个月，对数秩检验p = 0.002）。
在多因素模型中，常规影像监测与胰十二指肠切除术后的总生存延长相关。这是一个有待前瞻性研究验证的发现，最终可能会影响监测指南。
