Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, 06120, Halle (Saale), Germany.
Sci Rep. 2020 Mar 10;10(1):4444. doi: 10.1038/s41598-020-61487-0.
Surgery for metastatic pancreatic cancer remains controversial as the survival benefit is questionable. The aim of the present study was to analyze the survival of these patients using data extracted from the surveillance, epidemiology, and end results (SEER) program database. Further, studies on resection for metastatic disease to the lung were systematically reviewed. A total of 11,541 cases with synchronous distant metastasis were analyzed. The median survival of single-organ metastasis was better than of multi-organ metastasis (single-organ 4.0 ± 0.07 months, two-organs 3.0 ± 0.13 months, three/four-organs 2.0 ± 0.19 months; p < 0.0001). Single organ lung metastasis had longer median survival times compared to the other sites (lung 6.0 ± 0.32 months, HR 0.87, 95% CI 0.78-0.97; p = 0.013). Resection of the primary tumor was associated with longer survival in synchronous single-organ metastasis to the lung compared to no resection (14.0 ± 1.93 months vs 6.0 ± 0.31 months, p < 0.0001). A systematic literature review identified 79 cases of metachronous lung metastasis with a survival of 120.0 ± 6.32 months and 83.0 ± 24.84 months following resection of the primary tumor and metastasis, respectively. Lower TNM staging, longer interval to metastasis, and single metastatic lesion correlated with better survival. Resection in highly selected pancreatic cancer patients with synchronous and metachronous lung only metastasis might confer a survival benefit and should be considered on an individual basis.
手术治疗转移性胰腺癌仍存在争议，因为其生存获益值得怀疑。本研究旨在利用监测、流行病学和最终结果（SEER）数据库中的数据来分析这些患者的生存情况。此外，还对肺转移瘤切除术进行了系统回顾。共分析了 11541 例同时性远处转移病例。单器官转移的中位生存时间优于多器官转移（单器官 4.0±0.07 个月，双器官 3.0±0.13 个月，三/四器官 2.0±0.19 个月；p<0.0001）。与其他部位相比，单一肺转移的中位生存时间更长（肺 6.0±0.32 个月，HR 0.87，95%CI 0.78-0.97；p=0.013）。与未行切除术相比，同步单器官肺转移患者行原发肿瘤切除术与更长的生存时间相关（14.0±1.93 个月比 6.0±0.31 个月，p<0.0001）。系统文献回顾确定了 79 例肺转移的病例，分别行原发肿瘤和转移灶切除术的生存时间为 120.0±6.32 个月和 83.0±24.84 个月。较低的 TNM 分期、较长的转移时间间隔和单个转移病灶与更好的生存相关。在高度选择的同时性和异时性肺转移仅有胰腺癌患者中进行切除术可能带来生存获益，应根据个体情况考虑。
