胰十二指肠切除术在一部分老年胰腺导管腺癌患者中是合理的：基于人群的 4283 例患者回顾性队列研究。

Pancreaticoduodenectomy is justified in a subset of elderly patients with pancreatic ductal adenocarcinoma: A population-based retrospective cohort study of 4,283 patients.

机构信息

Department of Epidemiology, Dalian Medical University, China.

The First Affiliated Hospital of Dalian Medical University, China; Institute for Experimental Surgery, Rostock University Medical Center, Germany.

出版信息

Int J Surg. 2018 May;53:262-268. doi: 10.1016/j.ijsu.2018.03.054. Epub 2018 Mar 29.

DOI:10.1016/j.ijsu.2018.03.054

PMID:29604352

Abstract

BACKGROUND

The survival benefit of pancreaticoduodenectomy (PD) in elderly patients with pancreatic ductal adenocarcinoma (PDAC) is still unclear.

METHODS

Data pertaining to elderly (age ≥75 years) and younger (age <75 years) patients with potentially curable PDAC who underwent pancreaticoduodenectomy in the period 2004-2013 were extracted from the Surveillance, Epidemiology, and End Results database. The Cox proportional hazards model and stratified Kaplan-Meier survival analyses were performed.

RESULTS

A total of 4283 patients (3256 younger patients and 1027 elderly patients) were included. On multivariate analysis, advanced age (age ≥75 years) was not found to be an independent risk factor for diseases specific survival (DSS). Survival analysis disaggregated by gender, tumor size, American Joint Committee on Cancer stage, and tumor differentiation showed comparable DSS in younger and elderly patients (log-rank test). Among patients with poorly-differentiated or undifferentiated tumors, those in the elderly age-group experienced shorter DSS as compared to that of younger patients (poorly-differentiated: elderly vs. younger, 32.779 months vs. 42.198 months, P = 0.043; undifferentiated: elderly vs. younger, 17.500 months vs. 43.028 months, P = 0.210). However, PD was still warranted for elderly patients with poorly-differentiated tumors (surgery vs. without surgery, 32.779 months vs. 11.490 months, P < 0.001). Patients with undifferentiated tumors experienced a non-significant survival benefit after PD (surgery vs. without surgery, 17.500 months vs. 11.699 months, P = 0.330).

CONCLUSIONS

Advanced age (age ≥75 years) is not an independent risk factor for DSS. PD is justified in a subset of elderly PDAC patients; however, it should be performed in a high-volume center to minimize the risk of post operative complications. Future studies should explore individualized treatment strategies for elderly patients with undifferentiated tumors.

摘要

背景

在接受胰十二指肠切除术（PD）的老年患者中，胰腺导管腺癌（PDAC）的生存获益仍不明确。

方法

从监测、流行病学和最终结果数据库中提取了 2004 年至 2013 年间接受胰十二指肠切除术的潜在可治愈 PDAC 的老年（年龄≥75 岁）和年轻（年龄<75 岁）患者的数据。采用 Cox 比例风险模型和分层 Kaplan-Meier 生存分析。

结果

共纳入 4283 例患者（3256 例年轻患者和 1027 例老年患者）。多因素分析显示，高龄（年龄≥75 岁）并非疾病特异性生存（DSS）的独立危险因素。按性别、肿瘤大小、美国癌症联合委员会分期和肿瘤分化进行生存分析显示，年轻和老年患者的 DSS相似（对数秩检验）。在分化差或未分化的肿瘤患者中，老年患者的 DSS较年轻患者短（分化差：老年 vs. 年轻，32.779 个月 vs. 42.198 个月，P=0.043；未分化：老年 vs. 年轻，17.500 个月 vs. 43.028 个月，P=0.210）。然而，对于分化差的肿瘤患者，PD 仍然是必要的（手术 vs. 无手术，32.779 个月 vs. 11.490 个月，P<0.001）。未分化肿瘤患者接受 PD 后生存获益无显著差异（手术 vs. 无手术，17.500 个月 vs. 11.699 个月，P=0.330）。