Dept. of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland, PL 2000, 33521 Tampere, Finland.
Dept. of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland, PL 66, 33101 Tampere, Finland.
Pancreatology. 2017 Sep-Oct;17(5):822-826. doi: 10.1016/j.pan.2017.07.192. Epub 2017 Jul 29.
Long-term survival of patients with operated pancreatic ductal adenocarcinoma (PDAC) has been associated with resection status, disease stage and centralisation. However, no previous reports are available about long-term survivors of PDAC with confirmed histology covering an entire nation. Our aim was to analyze retrospectively confirmed long-term survivors of PDAC operated on in Finland 2000-2008.
PDAC patients operated between 2000 and 2008 were selected from Finnish patient registers and archives. Histological slides of patients with over four-year survival were re-evaluated by an expert pancreatic pathologist. From the confirmed PDAC patients, demographic, oncologic and operative parameters were recorded. The cut-point of survival was 31.12.2013.
Out of the 598 patients operated on and originally diagnosed with PDAC, 52 of the long-term survivors (LTS) were confirmed as having had true PDAC. The four-year survival rate in high volume centres (HVC) was 13.0% and 6.7% elsewhere (p = 0.017). Five-year survival rate was 7.2%. After multivariate analysis only the size of the tumour persisted as prognostic factor for over four-year survival. Among LTSs, 50% of patients had stage IIB tumour and 40% had a R1 resection without difference with patients with shorter survival. The use of adjuvant therapy did not differ between the groups.
This is the largest single-nationwide cohort of long-term survivors with confirmed PDAC. Comprehensive pathological evaluation is mandatory for an adequate PDAC diagnosis and true survival analysis. Long-term survival can be achieved even in T3 patients with nodal involvement and may be explained by favorable tumour biology.
接受手术治疗的胰腺导管腺癌（PDAC）患者的长期生存与切除状态、疾病分期和集中化治疗相关。然而，目前尚无关于在整个国家范围内对经组织学证实的 PDAC 长期生存患者进行回顾性分析的报道。我们的目的是分析 2000-2008 年在芬兰接受手术治疗的 PDAC 长期生存患者。
从芬兰患者登记处和档案中选择 2000 年至 2008 年间接受手术治疗的 PDAC 患者。由一位胰腺病理专家对生存时间超过四年的患者的组织学切片进行重新评估。从经证实的 PDAC 患者中，记录人口统计学、肿瘤学和手术相关参数。生存时间的截止点为 2013 年 3 月 12 日。
在接受手术治疗且最初诊断为 PDAC 的 598 例患者中，有 52 例长期生存患者（LTS）被证实为真正患有 PDAC。高容量中心（HVC）的四年生存率为 13.0%，而其他中心为 6.7%（p=0.017）。五年生存率为 7.2%。多因素分析显示，只有肿瘤大小仍然是四年以上生存的预后因素。在 LTS 中，50%的患者为 IIB 期肿瘤，40%的患者为 R1 切除，但与生存时间较短的患者相比无差异。各组之间辅助治疗的使用无差异。
这是最大的单一国家范围内的经组织学证实的 PDAC 长期生存患者队列。综合病理评估对于准确的 PDAC 诊断和真实的生存分析至关重要。即使在有淋巴结转移的 T3 患者中，也可以实现长期生存，这可能是由于肿瘤生物学的有利因素所致。
