Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Ann Surg. 2020 Jun;271(6):1148-1155. doi: 10.1097/SLA.0000000000003083.
To reappraise the concept of conditional survival (CS) following pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), accounting for the patient's present disease status relative to recurrence.
CS, defined as the probability of surviving an additional time frame based on accrued lifespan, offers dynamic survival projections as compared with baseline overall survival.
Patients undergoing pancreatectomy for PDAC at 2 institutions from 2000 to 2013 were retrospectively analyzed. The 12-month CS was estimated separately for patients who were disease-free or with recurrence at the given time points. Next, the conditional probability of reaching 60-months of survival was examined in each conditioning set across strata of prognostic covariates, including American Joint Committee on Cancer stage, tumor grade, R-status, and adjuvant treatment.
The study population consisted of 1005 patients. In disease-free patients, the 12-month CS increased as a function of time already survived, showing an opposite trend compared with overall survival. In patients who recurred, the 12-month CS was lower than the disease-free counterpart, especially within 24 months postoperatively. When stratifying by the levels of prognostic covariates, the 60-months CS estimates for disease-free patients tended to level off progressively, indicating that factors independently associated with survival at the time of pancreatectomy lost power over time. This concept did not apply to the conditioning set of patients with recurrence, where CS estimates across variables strata diverged with accrued lifespan.
This paper provides new information on how prognosis following pancreatectomy for PDAC evolves over time, adjusting for the time the patient already survived, and for the patient's present disease status relative to recurrence.
重新评估胰腺导管腺癌（PDAC）胰腺切除术后的条件生存（CS）概念，考虑到患者相对于复发的当前疾病状态。
CS 定义为基于累计寿命存活额外时间段的概率，与基线总生存相比提供动态生存预测。
对 2000 年至 2013 年在 2 个机构接受 PDAC 胰腺切除术的患者进行回顾性分析。分别为在给定时间点无疾病或有复发的患者估计 12 个月 CS。然后，在包括美国癌症联合委员会（AJCC）分期、肿瘤分级、R 状态和辅助治疗在内的预后协变量各分层中，检查达到 60 个月生存的条件概率。
研究人群包括 1005 名患者。在无疾病患者中，12 个月 CS 随已存活时间的增加而增加，与总生存呈相反趋势。在复发的患者中，12 个月 CS 低于无疾病患者，尤其是在术后 24 个月内。在按预后协变量水平分层时，无疾病患者的 60 个月 CS 估计值逐渐趋于平稳，表明与胰腺切除术时生存相关的独立因素随着时间的推移逐渐失去效力。这一概念不适用于有复发患者的条件集，其中 CS 估计值在变量分层之间随着累计寿命的增加而出现差异。
本文提供了有关 PDAC 胰腺切除术后随时间推移预后如何演变的新信息，同时考虑到患者已经存活的时间以及患者相对于复发的当前疾病状态。
