Department of Hepatobiliary Pancreatic and Transplant Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan.
Pancreatology. 2019 Mar;19(2):307-315. doi: 10.1016/j.pan.2019.01.020. Epub 2019 Jan 25.
We analyzed the significance of portal vein (PV) patency ratio (minimum diameter/maximum diameter) during preoperative chemoradiotherapy (CRT) on the outcomes of patients with pancreatic-ductal adenocarcinoma (PDAC).
The 261 PDAC patients had been prospectively registered to our CRT protocol (Gemcitabine or S1+Gemcitabine) from 2005 to 2015. Among them, the subjects were the 84 PDAC- patients with preoperative PV contact who underwent pancreatectomy with PV resection.
The 3- and 5-year disease-specific survival (DSS) rates of all 84 patients were 44% and 39%, respectively. Pathological PV invasion (pPV) was seen in 22, and PV patency ratio after CRT (cut-off:0.62) was most relevant factor to predict pPV (sensitivity:54.8%, specificity:91.9%, accuracy:81.5%). Multivariate analysis revealed that PV patency ratio after CRT and improvement of PV patency ratio were selected as independent prognostic indicators. The 3- and 5-year DSS in 39 patients with PV patency ratio after CRT >0.6 were significantly higher than those in 45 patients <0.6: 65% and 60% vs. 24% and 20% (p = 0.0001). The patients with PV patency ratio >0.6, were significantly associated with the lower incidence of pPV, higher response for CRT, and better R0 resection rate. Even when severe PV strictures were seen before CRT, DSS of the patients whose PV patency ratio had recovered after CRT was excellent compared with those without improvement.
The PV patency ratio and its improvement are new prognostic indicators for PDAC treated with preoperative CRT. Even when PV was severely constricted, patients could obtain favorable outcomes, if its patency had recovered after CRT.
我们分析了术前放化疗（CRT）期间门静脉（PV）通畅率（最小直径/最大直径）对胰腺导管腺癌（PDAC）患者结局的意义。
2005 年至 2015 年，我们前瞻性地将 261 例 PDAC 患者纳入我们的 CRT 方案（吉西他滨或 S1+吉西他滨），其中 84 例 PDAC 患者术前有 PV 接触，行胰腺切除术伴 PV 切除术。
84 例患者的 3 年和 5 年疾病特异性生存率（DSS）分别为 44%和 39%。22 例存在病理 PV 侵犯（pPV），CRT 后 PV 通畅率（临界值：0.62）是预测 pPV 的最相关因素（敏感性：54.8%，特异性：91.9%，准确性：81.5%）。多变量分析显示，CRT 后 PV 通畅率和 PV 通畅率改善是独立的预后指标。CRT 后 PV 通畅率>0.6 的 39 例患者的 3 年和 5 年 DSS 明显高于<0.6 的 45 例患者：65%和 60%比 24%和 20%（p=0.0001）。CRT 后 PV 通畅率>0.6 的患者，与 pPV 发生率较低、CRT 反应较好和 R0 切除率较高显著相关。即使在 CRT 前存在严重的 PV 狭窄，CRT 后 PV 通畅率恢复的患者的 DSS 也明显优于无改善的患者。
PV 通畅率及其改善是 PDAC 术前 CRT 的新预后指标。即使 PV 严重狭窄，如果 CRT 后恢复通畅，患者仍可获得良好的结局。
