Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2020 Oct;27(10):3898-3912. doi: 10.1245/s10434-020-08354-4. Epub 2020 Apr 19.
The authors hypothesized that in resected pancreatic adenocarcinoma (PDAC), pathologic characteristics, oncologic outcomes, prognostic factors, and the accuracy of the American Joint Committee on Cancer (AJCC) staging system might differ based on tumor location.
Patients undergoing pancreatectomy for PDAC at two academic institutions from 2000 to 2015 were retrieved. A comparative analysis between head (H-PDAC) and body-tail (BT-PDAC) tumors was performed using uni- and multivariable models. The accuracy of the eighth AJCC staging system was analyzed using C-statistics.
Among 1466 patients, 264 (18%) had BT-PDAC, which displayed greater tumor size but significantly lower rates of perineural invasion and G3/4 grading. Furthermore, BT-PDAC was associated with a lower frequency of nodal involvement and a greater representation of earlier stages. The recurrence-free survival and disease-specific survival times were longer for BT-PDAC (16 vs 14 months [p = 0.020] and 33 vs 26 months [p = 0.026], respectively), but tumor location was not an independent predictor of recurrence or survival in the multivariable analyses. The recurrence patterns did not differ. Certain prognostic factors (i.e., CA 19.9, grading, R-status, and adjuvant treatment) were common, whereas others were site-specific (i.e., preoperative pain, diabetes, and multivisceral resection). The performances of the AJCC staging system were similar (C-statistics of 0.573 for H-PDAC and 0.597 for BT-PDAC, respectively).
Despite differences in pathologic profile found to be in favor of BT-PDAC, tumor location was not an independent predictor of recurrence or survival after pancreatectomy. An array of site-specific prognostic factors was identified, but the AJCC staging system displayed similar prognostic power regardless of primary tumor location.
作者假设在切除的胰腺腺癌（PDAC）中，肿瘤位置可能会影响病理特征、肿瘤学结果、预后因素以及美国癌症联合委员会（AJCC）分期系统的准确性。
从 2000 年至 2015 年，在两个学术机构接受胰腺切除术治疗 PDAC 的患者被检索出来。使用单变量和多变量模型对头部（H-PDAC）和体尾部（BT-PDAC）肿瘤进行了比较分析。使用 C 统计量分析了第八版 AJCC 分期系统的准确性。
在 1466 名患者中，有 264 名（18%）患有 BT-PDAC，其肿瘤体积更大，但神经侵犯和 G3/4 分级的发生率明显较低。此外，BT-PDAC 淋巴结受累的频率较低，早期分期的比例更高。BT-PDAC 的无复发生存和疾病特异性生存时间更长（16 个月比 14 个月[P=0.020]和 33 个月比 26 个月[P=0.026]），但肿瘤位置在多变量分析中并不是复发或生存的独立预测因素。复发模式没有差异。某些预后因素（即 CA19.9、分级、R 状态和辅助治疗）是常见的，而其他因素是特定部位的（即术前疼痛、糖尿病和多脏器切除）。AJCC 分期系统的性能相似（H-PDAC 的 C 统计量为 0.573，BT-PDAC 的 C 统计量为 0.597）。
尽管 BT-PDAC 的病理特征存在优势，但肿瘤位置并不是胰腺切除术后复发或生存的独立预测因素。确定了一系列特定部位的预后因素，但无论原发肿瘤位置如何，AJCC 分期系统都显示出相似的预后能力。
