Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA; Department of Surgery, Mayo Clinic, Rochester, MN; Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA.
Surgery. 2020 May;167(5):803-811. doi: 10.1016/j.surg.2019.12.008. Epub 2020 Jan 25.
Resection margin status has been recognized as an independent prognostic factor on overall survival in pancreatic cancer patients undergoing surgical resection. However, its impact after neoadjuvant treatment remains uncertain.
We analyzed 305 patients with resectable or borderline resectable pancreatic cancer treated with neoadjuvant therapy and pancreatoduodenectomy at 3 tertiary referral centers between 2010 and 2017. Positive resection margin was defined as 1 or more cancer cells at any margin. Overall survival was measured from the date of surgery until death or last follow-up.
One hundred and seventy-eight patients received neoadjuvant chemotherapy and 127 received neoadjuvant chemoradiotherapy. The median overall survival was 29.8 months. The 1-, 3-, and 5-year overall survival rates were 79.2%, 44.0%, and 23.5%, respectively. Negative margin was achieved in 275 (90.2%) patients. Negative margin resection patients had a significantly longer overall survival than positive resection margin patients (31.3 vs 16.3 months, P < .001). In univariate analyses, overall survival was associated with age, margin status, histologic grade, ypT, number of positive lymph nodes, perineural invasion, treatment effect, postoperative carbohydrate antigen 19-9, and adjuvant therapy. Positive margin resection, poorly differentiated carcinoma, treatment effect score of 3, postoperative carbohydrate antigen 19-9 of 37 U/mL or higher, and lack of adjuvant therapy were predictive of poor overall survival in multivariate Cox regression analysis.
Margin status was an independent predictor of overall survival in patients treated with neoadjuvant therapy and pancreatoduodenectomy, supporting the use of a negative margin resection as a surrogate of adequate oncological resection in this setting. Our findings may also have significant implications for patient stratification in future randomized trials.
在接受手术切除的胰腺癌患者中，切缘状态已被认为是总生存率的独立预后因素。然而，其在新辅助治疗后的影响尚不确定。
我们分析了 2010 年至 2017 年间在 3 家三级转诊中心接受新辅助治疗和胰十二指肠切除术的 305 例可切除或交界可切除的胰腺癌患者。阳性切缘定义为任何切缘有 1 个或多个癌细胞。总生存期从手术日期计算至死亡或最后一次随访。
178 例患者接受新辅助化疗，127 例患者接受新辅助放化疗。中位总生存期为 29.8 个月。1、3、5 年总生存率分别为 79.2%、44.0%和 23.5%。275 例（90.2%）患者获得阴性切缘。阴性切缘患者的总生存率显著长于阳性切缘患者（31.3 与 16.3 个月，P<0.001）。单因素分析显示，总生存率与年龄、切缘状态、组织学分级、ypT、阳性淋巴结数量、神经周围侵犯、治疗效果、术后糖类抗原 19-9 和辅助治疗有关。多因素 Cox 回归分析显示，阳性切缘、低分化癌、治疗效果评分 3 分、术后糖类抗原 19-9 为 37U/mL 或更高、缺乏辅助治疗是总生存不良的预测因素。
在接受新辅助治疗和胰十二指肠切除术的患者中，切缘状态是总生存率的独立预测因素，支持将阴性切缘作为该治疗环境下充分肿瘤切除的替代指标。我们的发现也可能对未来随机试验中的患者分层具有重要意义。
