Addeo Pietro, Velten Michel, Averous Gerlinde, Faitot François, Nguimpi-Tambou Marlene, Nappo Gennaro, Felli Emanuele, Fuchshuber Pascal, Bachellier Philippe
Hepato-Pancreato-Biliary Surgery and Liver transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France; Cancer Registry of Bas-Rhin, Faculty of medicine, University of Strasbourg, Strasbourg, France.
Cancer Registry of Bas-Rhin, Faculty of medicine, University of Strasbourg, Strasbourg, France.
Surgery. 2017 Aug;162(2):264-274. doi: 10.1016/j.surg.2017.03.008. Epub 2017 May 30.
Incomplete evaluation of venous invasion has led to conflicting results regarding the prognosis of patients undergoing pancreatectomy with a synchronous venous resection. This study evaluates the prognostic value associated with the presence and the depth of venous invasion in T3 pancreatic adenocarcinoma.
This study evaluated retrospectively 181 consecutive pancreatoduodenectomies performed for T3N0M0 and T3N1M0 pancreatic adenocarcinomas (stages IIA and IIB) from January 2006 to December 2014. Univariate and multivariate Cox analyses were performed to assess survival prognostic factors.
Pancreatoduodenectomies with a segmental venous resection was performed on 91 patients, while 90 other patients had a standard pancreatoduodenectomies without venous resection. Pathologic venous invasion was detected in 68 (74%) of the 91 venous resection patients. Depth of venous invasion was into the adventitia (n = 25), media (n = 28), and intima (n = 15). The overall survival rates at 1, 3, 5, and 10 years were 75%, 33%, 21%, and 6%, respectively. There were no differences in survival between patients undergoing standard pancreatoduodenectomies and pancreatoduodenectomies with venous resection (27 vs 22 months; P = .28) or between patients with and without venous invasion (20 vs 27 months; P = .08). In multivariate analysis, depth of venous invasion into the intima (hazard ratio, 2.25; 95% confidence interval, 1.16-4.34; P = .0001) and adjuvant chemotherapy (hazard ratio, 0.16; 95% confidence interval, 0.09-0.43; P ≤ .0001) were identified as independent prognostic factors of overall survival.
Depth of venous invasion into the intima indicates poor survival in pancreatic T3 adenocarcinoma. Preoperative identification of this factor could be helpful for better selection of patients for curative operation.
对静脉侵犯的评估不完整导致了关于同步静脉切除的胰腺癌患者预后的结果相互矛盾。本研究评估了T3期胰腺腺癌中静脉侵犯的存在及深度与预后的相关性。
本研究回顾性评估了2006年1月至2014年12月期间因T3N0M0和T3N1M0胰腺腺癌（IIA期和IIB期）而连续进行的181例胰十二指肠切除术。进行单因素和多因素Cox分析以评估生存预后因素。
91例患者进行了节段性静脉切除的胰十二指肠切除术，而其他90例患者进行了无静脉切除的标准胰十二指肠切除术。91例静脉切除患者中有68例（74%）检测到病理静脉侵犯。静脉侵犯深度达外膜（n = 25）、中膜（n = 28）和内膜（n = 15）。1年、3年、5年和10年的总生存率分别为75%、33%、21%和6%。接受标准胰十二指肠切除术的患者与接受静脉切除的胰十二指肠切除术的患者之间的生存率无差异（27个月对22个月；P = 0.28），有静脉侵犯和无静脉侵犯的患者之间也无差异（20个月对27个月；P = 0.08）。在多因素分析中，静脉侵犯至内膜的深度（风险比，2.25；95%置信区间，1.16 - 4.34；P = 0.0001）和辅助化疗（风险比，0.16；95%置信区间，0.09 - 0.43；P≤0.0001）被确定为总生存的独立预后因素。
静脉侵犯至内膜的深度表明胰腺T3腺癌患者生存不良。术前识别该因素有助于更好地选择适合根治性手术的患者。
