Department of Surgery I, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, 77520 Olomouc, Czech Republic.
Department of Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, 77520 Olomouc, Czech Republic.
World J Gastroenterol. 2017 Sep 21;23(35):6420-6428. doi: 10.3748/wjg.v23.i35.6420.
To analyze pancreatic cancer patients who developed metachronous pulmonary metastases (MPM) as a first site of recurrence after the curative-intent surgery.
One-hundred-fifty-nine consecutive pancreatic ductal adenocarcinoma (PDAC) patients who underwent radical pancreatic surgery between 2006 and 2013 were included in this retrospective analysis. The clinical data including age, sex, grade, primary tumor location, pTNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered, and follow-up were all obtained from medical records. Further analysis covered only patients with metachronous metastases. Clinical and histopathological data (age, sex, grade, primary tumor location, pTNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered and follow-up) of patients with metachronous non-pulmonary metastases and patients with metachronous pulmonary metastases were statistically assessed. Disease-free survival (DFS) from pancreas resection until metastases onset and overall survival (OS) were calculated. Wilcoxon test, χ test and survival functions computed by the Kaplan-Meier method were used. Statistical significance was evaluated by the log-rank test using SPSS. A -value of less than 0.05 was considered statistically significant.
Metachronous pulmonary metastases were observed in 20 (16.9%) and were operable in 3 (2.5%) of PDAC patients after a prior curative-intent surgery. Patients with isolated pulmonary metastases (oligometastases and multiple metastases) had estimated prior DFS and OS of 35.4 and 81.4 mo, respectively, and those with metachronous pulmonary metastases accompanied by other metastases had prior DFS and OS of 17.3 and 23.4 mo, respectively. Patients with non-pulmonary metastases had prior DFS and OS of 9.4 and 15.8 mo, respectively. Different clinical scenarios according to the presentation of MPM were observed and patients could be divided to three subgroups with different prognosis which could be used for the selection of treatment strategy: isolated pulmonary oligometastases, isolated multiple pulmonary metastases and pulmonary metastases accompanied by other metastases.
Surgery should be considered for all patients with isolated pulmonary oligometastases, but the risk of intervention has to be individually weighted for each patient.
分析根治性手术后发生异时性肺转移（MPM）作为首发复发部位的胰腺癌患者。
本回顾性分析纳入了 2006 年至 2013 年间接受根治性胰腺手术的 159 例胰腺导管腺癌（PDAC）患者。从病历中获得了包括年龄、性别、分级、原发肿瘤位置、pTNM 分期、淋巴结浸润、微血管侵犯、神经周围侵犯、血管淋巴管侵犯、治疗方法和随访在内的所有临床数据。进一步的分析仅涵盖异时性转移患者。对异时性非肺转移患者和异时性肺转移患者的临床和组织病理学数据（年龄、性别、分级、原发肿瘤位置、pTNM 分期、淋巴结浸润、微血管侵犯、神经周围侵犯、血管淋巴管侵犯、治疗方法和随访）进行统计学评估。计算从胰腺切除到转移发生的无病生存期（DFS）和总生存期（OS）。采用 Wilcoxon 检验、χ 检验和 Kaplan-Meier 法计算生存函数。采用 Log-rank 检验用 SPSS 进行统计学分析。P 值小于 0.05 为有统计学意义。
20 例（16.9%）PDAC 患者在根治性手术后发生异时性肺转移，其中 3 例（2.5%）为可切除转移灶。孤立性肺转移（寡转移和多发转移）患者的估计DFS 和 OS 分别为 35.4 和 81.4 个月，而伴有其他转移的异时性肺转移患者的 DFS 和 OS 分别为 17.3 和 23.4 个月。非肺转移患者的 DFS 和 OS 分别为 9.4 和 15.8 个月。观察到不同的临床情况，根据 MPM 的表现，患者可分为三个不同预后的亚组，可用于治疗策略的选择：孤立性肺寡转移、孤立性多发性肺转移和肺转移伴其他转移。
应考虑对所有孤立性肺寡转移患者进行手术，但必须对每位患者的干预风险进行个体化权衡。
