重复胰腺切除术后术前淋巴细胞与单核细胞比值作为侵袭性胰腺肿瘤患者预后指标的长期结果和意义。
Long-term outcomes and significance of preoperative lymphocyte-to-monocyte ratio as a prognostic indicator in patients with invasive pancreatic neoplasms after repeat pancreatectomy.
机构信息
Department of General Surgery, Chiba University, Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.
出版信息
BMC Cancer. 2020 Feb 10;20(1):111. doi: 10.1186/s12885-020-6602-4.
BACKGROUND
Invasive pancreatic neoplasms have a high propensity for recurrence even after curative resection. Recently, patients who underwent pancreatectomy have an opportunity of undergoing secondary pancreatic resection, so-called "repeat pancreatectomy" to achieve curative operation and prolong their survival. We evaluated the long-term clinical outcomes and identified the prognostic factors, including systemic inflammation markers and the lymphocyte-to-monocyte ratio (LMR) of patients who underwent repeat pancreatectomy for invasive pancreatic tumors.
METHODS
Twenty-eight consecutive patients with invasive pancreatic neoplasms (22 pancreatic ductal adenocarcinomas, 2 pancreatic acinar cell carcinomas, and 4 invasive intra-papillary mucinous carcinomas) with isolated local recurrence only in the remnant pancreas were analyzed retrospectively. To identify factors for the selection of optimal patients who should undergo repeat pancreatectomy, perioperative clinical parameters were analyzed by Cox proportional regression models.
RESULTS
Of 28 patients, 12 patients experienced recurrence within 3 years after repeat pancreatectomy. Kaplan-Meier analysis showed that the median cancer-specific overall survival time of patients with invasive pancreatic neoplasms was 61 months, showing favorable outcomes. High preoperative LMR (LMR ≥ 3.3) (p = 0.022), no portal vein resection (p = 0.021), no arterial resection (p = 0.037), and pathological lymph node negative (p = 0.0057) were identified as favorable prognostic parameters on univariate analysis, and LMR ≥ 3.3 (p = 0.0005), and pathological lymph node negative (p = 0.018) on multivariate analysis.
CONCLUSIONS
Preoperative LMR is potentially a good indicator for selecting suitable patients to undergo repeat pancreatectomy in patients with isolated local recurrence of invasive pancreatic neoplasms.
背景
即使在根治性切除后，侵袭性胰腺肿瘤也有很高的复发倾向。最近，接受胰腺切除术的患者有机会进行二次胰腺切除术，即所谓的“重复胰腺切除术”，以实现根治性手术并延长生存时间。我们评估了长期临床结果，并确定了包括系统性炎症标志物和淋巴细胞与单核细胞比值（LMR）在内的预后因素，这些因素与接受重复胰腺切除术治疗侵袭性胰腺肿瘤的患者相关。
方法
回顾性分析了 28 例仅在残胰腺中孤立局部复发的侵袭性胰腺肿瘤患者（22 例胰腺导管腺癌、2 例胰腺腺泡细胞癌和 4 例侵袭性胰内黏液性癌）。为了确定选择应行重复胰腺切除术的最佳患者的因素，通过 Cox 比例回归模型分析了围手术期临床参数。
结果
在 28 例患者中，有 12 例患者在重复胰腺切除术后 3 年内复发。Kaplan-Meier 分析显示，侵袭性胰腺肿瘤患者的癌症特异性总生存时间中位数为 61 个月，预后良好。术前高 LMR（LMR≥3.3）（p=0.022）、无门静脉切除（p=0.021）、无动脉切除（p=0.037）和病理淋巴结阴性（p=0.0057）是单因素分析中有利的预后参数，LMR≥3.3（p=0.0005）和病理淋巴结阴性（p=0.018）是多因素分析中的有利预后参数。
结论
术前 LMR 可能是选择适合接受重复胰腺切除术的侵袭性胰腺肿瘤孤立性局部复发患者的良好指标。
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