Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Ann Surg Oncol. 2018 Mar;25(3):638-646. doi: 10.1245/s10434-017-6274-8. Epub 2017 Dec 20.
The prognostic impact of pancreatic ductal adenocarcinoma (PDAC) invasion to the splenic vessel is controversial.
The aim of this study was to assess the clinical value of pathological and radiological splenic vessel invasion in PDACs of the body and tail.
Medical records of patients with resectable PDAC of the body and tail who underwent distal pancreatectomy between 2003 and 2016 at the Kobe University Hospital were retrospectively analyzed.
Overall, 68 patients (29 female and 39 male patients) were enrolled. Pathologically determined splenic vein invasion (p-SV) and splenic artery invasion (p-SA) were identified in 21 (30.9%) and 5 (7.4%) patients, respectively. The p-SV (but not p-SA) was an independent prognostic factor in multivariate analysis (p = 0.009). On analysis of recurrence patterns, patients with PDAC positive for p-SV were at a higher risk for liver metastasis (p = 0.022); however, the associations were not significant for other recurrence patterns. Liver metastasis occurred earlier in patients who were positive for p-SV (p = 0.015). Preoperative computed tomography effectively diagnosed pathological vessel invasion (SV: sensitivity, 95.2%, specificity, 72.3%; SA: sensitivity, 100%, specificity, 84.1%). Radiological SV invasion remained significant in multivariate analysis regarding postoperative survival (p = 0.007), and was also associated with early liver metastases (p = 0.008).
Pathological/radiological SV invasion were independent adverse prognostic factors associated with early liver metastasis in patients with PDAC of the body/tail. Assessment of these findings may be useful in determining optimal therapeutic options in these patients.
胰腺导管腺癌（PDAC）侵犯脾血管的预后影响存在争议。
本研究旨在评估 PDAC 体尾部病理和影像学脾血管侵犯的临床价值。
回顾性分析 2003 年至 2016 年期间在神户大学医院接受胰体尾切除术的可切除 PDAC 患者的病历。
共有 68 名患者（29 名女性和 39 名男性）入组。病理确定脾静脉侵犯（p-SV）和脾动脉侵犯（p-SA）分别在 21 名（30.9%）和 5 名（7.4%）患者中发现。多变量分析显示，p-SV（而非 p-SA）是独立的预后因素（p=0.009）。在分析复发模式时，p-SV 阳性的 PDAC 患者发生肝转移的风险更高（p=0.022）；然而，其他复发模式的相关性不显著。p-SV 阳性患者的肝转移发生更早（p=0.015）。术前 CT 有效诊断了病理血管侵犯（SV：敏感性 95.2%，特异性 72.3%；SA：敏感性 100%，特异性 84.1%）。在多变量分析中，影像学 SV 侵犯与术后生存相关（p=0.007），并与早期肝转移相关（p=0.008）。
病理/影像学 SV 侵犯是 PDAC 体尾部患者独立的不良预后因素，与早期肝转移相关。评估这些发现可能有助于确定这些患者的最佳治疗方案。
