Yin Zi, Ma Tingting, Chen Sheng
Gynecology and Obstetrics Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Pancreas. 2019 Apr;48(4):519-525. doi: 10.1097/MPA.0000000000001266.
The prognostic implications of intraoperative peritoneal washing cytology (IPWC) in patients with pancreatic ductal adenocarcinoma (PDAC) remains incompletely understood.
A meta-analysis was conducted to investigate the impact of IPWC status on the clinicopathologic features and survival outcomes in potentially resectable, locally advanced, and metastatic PDAC. Hazard ratio (HR) and 95% confidence interval (CI) were used as the pooled estimates.
A total of 12 studies qualified for inclusion with 3751 PDAC patients. In resectable PDAC, the postoperative 5-year overall survival was significantly better in negative IPWC than in positive IPWC patients, with a pooled HR of 2.47 (95% CI, 1.90-3.21; P < 0.001; I = 69%) in a random-effects model. Likely, combined outcome showed a significantly longer survival benefit in the negative IPWC group (HR, 2.80; 95% CI, 1.94-4.04; P < 0.001) in terms of recurrence-free survival. The presence of positive IPWC did not significantly alter survival outcomes in those PDAC patients with locally advanced or metastatic disease.
This systematic review and meta-analysis demonstrated that a positive IPWC status in patients with clinically resectable PDAC predicts a poor prognosis. Patients with positive IPWC should be regarded as a specific subgroup, with intensive adjuvant chemotherapy that seems to be warranted for further evaluation.
术中腹腔冲洗细胞学检查（IPWC）对胰腺导管腺癌（PDAC）患者的预后影响仍未完全明确。
进行一项荟萃分析，以研究IPWC状态对潜在可切除、局部晚期和转移性PDAC患者的临床病理特征及生存结局的影响。风险比（HR）和95%置信区间（CI）用作汇总估计值。
共有12项研究符合纳入标准，涉及3751例PDAC患者。在可切除的PDAC中，IPWC阴性患者的术后5年总生存率显著高于IPWC阳性患者，随机效应模型中的汇总HR为2.47（95%CI，1.90 - 3.21；P < 0.001；I² = 69%）。同样，综合结局显示，在无复发生存方面，IPWC阴性组的生存获益显著更长（HR，2.80；95%CI，1.94 - 4.04；P < 0.001）。IPWC阳性的存在并未显著改变局部晚期或转移性疾病的PDAC患者的生存结局。
本系统评价和荟萃分析表明，临床可切除的PDAC患者中IPWC阳性状态预示预后不良。IPWC阳性的患者应被视为一个特定亚组，强化辅助化疗似乎有必要进一步评估。
