内镜超声检查可避免胰腺腺癌和未检出的腹膜癌病患者行不必要的剖腹手术。

Endoscopic ultrasonography can avoid unnecessary laparotomies in patients with pancreatic adenocarcinoma and undetected peritoneal carcinomatosis.

机构信息

Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain.

Oncology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain.

出版信息

Pancreatology. 2017 Sep-Oct;17(5):858-864. doi: 10.1016/j.pan.2017.08.004. Epub 2017 Aug 19.

DOI:10.1016/j.pan.2017.08.004

PMID:28844696

Abstract

BACKGROUND/OBJECTIVE: To assess the relationship between the presence of ascites detected by endoscopic ultrasonography (EUS) and peritoneal carcinomatosis (PC) in patients with pancreatic adenocarcinoma.

METHODS

Consecutive patients who underwent a EUS for preoperative staging of a pancreatic adenocarcinoma between 1998 and 2014 were retrospectively reviewed. The diagnosis of PC was confirmed by histopathology or peritoneal fluid cytology. The main outcome of the study was the relationship of ascites at EUS and PC in patients with pancreatic cancer. Secondarily, to evaluate the relationship between this finding and survival as well as the development of PC during follow-up.

RESULTS

A total of 136 patients were included: 30 patients with local unresectable tumor or metastatic disease and 106 potentially-resectable candidates based on CT staging. EUS showed ascites in 27 (20%) patients, of whom 8 (29.6%) had PC. The sensitivity, specificity, PPV, NPV and accuracy of ascites by EUS in the detection of PC in this group of patients were 67%, 85%, 30%, 96% and 83%, respectively. Ascites detected by EUS was the only independent predictive factor of PC with an OR of 11 (CI 95%: 3-40). The detection of ascites by EUS was associated with a shorter survival (median survival time 7,3 months; range 0-60 vs 14.2 months; range 0-140) (p = 0.018) and earlier development of PC during follow-up (median 3.2 months, range 1.4-18.1 vs 12.7 months, range 5.4-54.8; p = 0.003).

CONCLUSION

The finding of ascites at EUS in patients with pancreatic adenocarcinoma is highly associated with PC and a poor outcome.

摘要

背景/目的：评估内镜超声检查（EUS）检测到的腹水与胰腺腺癌患者腹膜癌病（PC）之间的关系。

方法

回顾性分析 1998 年至 2014 年间接受 EUS 术前分期的胰腺腺癌连续患者。PC 的诊断通过组织病理学或腹腔液细胞学确认。本研究的主要结局是在胰腺癌症患者中，EUS 检查腹水与 PC 的关系。其次，评估这一发现与生存以及随访期间 PC 发展之间的关系。

结果

共纳入 136 例患者：30 例局部不可切除肿瘤或转移性疾病患者和 106 例基于 CT 分期的潜在可切除患者。EUS 显示 27 例（20%）患者存在腹水，其中 8 例（29.6%）存在 PC。EUS 检测该组患者 PC 时腹水的敏感性、特异性、PPV、NPV 和准确性分别为 67%、85%、30%、96%和 83%。EUS 检测到的腹水是 PC 的唯一独立预测因素，OR 为 11（95%CI：3-40）。EUS 检测到腹水与较短的生存时间相关（中位生存时间 7.3 个月；范围 0-60 与 14.2 个月；范围 0-140）（p=0.018），并且在随访期间较早发展为 PC（中位 3.2 个月，范围 1.4-18.1 与 12.7 个月，范围 5.4-54.8；p=0.003）。