Hyun Jong Jin, Rose J Bart, Alseidi Adnan A, Biehl Thomas R, Helton Scott, Coy David L, Kozarek Richard A, Rocha Flavio G
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.
J Surg Oncol. 2019 Aug;120(2):262-269. doi: 10.1002/jso.25498. Epub 2019 May 15.
Unlike pancreatic head tumors, little is known about the biological significance of radiographic vessel involvement with pancreatic body/tail adenocarcinoma. We hypothesized radiographic splenic vessel involvement may be an adverse prognostic factor.
All distal pancreatectomies performed for resectable pancreatic adenocarcinoma between 2000 and 2016 were reviewed and clinicopatholgic data were collected, retrospectively. Preoperative computed tomography imaging was re-reviewed and splenic vessel involvement was graded as none, abutment, encasement, or occlusion.
Among a total of 71 patients, splenic artery or vein encasement/occlusion was present in 41% (29 of 71) of patients, each. There were no significant differences in tumor size or grade, margin positivity, and perineural or lymphovascular invasion. However, splenic artery encasement/occlusion (P = 0.001) and splenic vein encasement/occlusion (P = 0.038) both correlated with lymph node positivity. Splenic artery encasement was associated with a reduced median overall survival (20 vs 30 months, P = 0.033). Multivariate analysis also showed that splenic artery encasement was an independent risk factor of worse survival (hazard ratio, 2.246; 95% confidence interval, 1.118-4.513; P = 0.023).
Patients with cancer of the body or tail of the pancreas presenting with radiographic encasement of the splenic artery, but not the splenic vein, have a poorer prognosis and perhaps should be considered for neoadjuvant therapy before an attempt at curative resection.
与胰头肿瘤不同，关于影像学上血管受累对胰体/尾腺癌的生物学意义知之甚少。我们推测影像学上脾血管受累可能是一个不良预后因素。
回顾性收集2000年至2016年间因可切除性胰腺腺癌而行远端胰腺切除术的所有病例，并收集临床病理数据。重新复查术前计算机断层扫描成像，将脾血管受累程度分为无、毗邻、包绕或闭塞。
在总共71例患者中，脾动脉或脾静脉包绕/闭塞的患者各占41%（71例中的29例）。肿瘤大小、分级、切缘阳性以及神经周围或脉管侵犯方面均无显著差异。然而，脾动脉包绕/闭塞（P = 0.001）和脾静脉包绕/闭塞（P = 0.038）均与淋巴结阳性相关。脾动脉包绕与中位总生存期缩短相关（20个月对30个月，P = 0.033）。多因素分析还显示，脾动脉包绕是生存较差的独立危险因素（风险比，2.246；95%置信区间，1.118 - 4.513；P = 0.023）。
胰体或胰尾癌患者若影像学上显示脾动脉被包绕而非脾静脉被包绕，则预后较差，或许在尝试根治性切除前应考虑新辅助治疗。
