Ocuin Lee M, Miller-Ocuin Jennifer L, Zenati Mazen S, Vargo John A, Singhi Aatur D, Burton Steven A, Bahary Nathan, Hogg Melissa E, Zeh Herbert J, Zureikat Amer H
Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
J Gastrointest Oncol. 2017 Aug;8(4):696-704. doi: 10.21037/jgo.2017.04.02.
The role of adjuvant chemoradiotherapy (CRT) following pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDA) remains controversial. Recent data suggest that increased margin clearance (MC: distance between tumor and cut surface) is associated with improved survival after PD, but the role of adjuvant CRT in patients with known MC is undefined. We sought to delineate the impact of adjuvant CRT on survival based on MC following PD.
Patients who underwent PD for PDA between 2002 and 2014 were retrospectively stratified into three groups based on MC: 0 mm, ≤1 mm, and >1 mm. The impact of CRT on survival in each MC group was determined by univariate and multivariate analysis.
Three hundred and ten patients with known MC were analyzed (0 mm =67, ≤1 mm =113, and >1 mm =130). Increasing MC was independently associated with improved OS (≤1 mm, HR 0.66, 95% CI 0.46-0.96, P=0.03; >1 mm, HR 0.51, 95% CI 0.35-0.75, P=0.001; compared to 0 mm). Adjuvant CRT was administered to 62 patients (20%). On margin-stratified multivariate analysis, adjuvant CRT was independently associated with increased OS in patients with ≤1 mm margins (HR 0.36; 95% CI 0.18-0.69, P=0.002) but not for 0 mm and >1 mm margins.
This analysis suggests that the benefit of adjuvant CRT may be restricted to patients with ≤1 mm MC after PD for pancreatic cancer.
胰腺癌（PDA）胰十二指肠切除术（PD）后辅助放化疗（CRT）的作用仍存在争议。近期数据表明，切缘阴性距（MC：肿瘤与手术切缘之间的距离）增加与PD术后生存率提高相关，但辅助CRT在已知MC患者中的作用尚不明确。我们试图明确PD术后基于MC的辅助CRT对生存率的影响。
回顾性分析2002年至2014年间因PDA接受PD的患者，根据MC将其分为三组：0mm、≤1mm和>1mm。通过单因素和多因素分析确定CRT对各MC组生存率的影响。
分析了310例已知MC的患者（0mm = 67例，≤1mm = 113例，>1mm = 130例）。MC增加与总生存期（OS）改善独立相关（≤1mm，HR 0.66，95%CI 0.46 - 0.96，P = 0.03；>1mm，HR 0.51，95%CI 0.35 - 0.75，P = 0.001；与0mm相比）。62例患者（20%）接受了辅助CRT。在按切缘分层的多因素分析中，辅助CRT与切缘≤1mm患者的OS增加独立相关（HR 0.36；95%CI 0.18 - 0.69，P = 0.002），但与切缘0mm和>1mm患者无关。
该分析表明，胰腺癌PD术后辅助CRT的获益可能仅限于MC≤1mm的患者。
