淋巴结阴性和阳性可切除胰腺癌的复发时间而非模式不同。
Timing But Not Patterns of Recurrence Is Different Between Node-negative and Node-positive Resected Pancreatic Cancer.
机构信息
Department of Gastrointestinal Surgery and Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
出版信息
Ann Surg. 2020 Aug;272(2):357-365. doi: 10.1097/SLA.0000000000003123.
OBJECTIVE
Our aim was to evaluate recurrence patterns of surgically resected PDAC patients with negative (pN0) or positive (pN1) lymph nodes.
SUMMARY BACKGROUND DATA
Pancreatic ductal adenocarcinoma (PDAC) is predicted to become the second leading cause of cancer death by 2030. This is mostly due to early local and distant metastasis, even after surgical resection. Knowledge about patterns of recurrence in different patient populations could offer new therapeutic avenues.
METHODS
Clinicopathologic data were collected for 546 patients who underwent resection of their PDAC between 2005 and 2016 from 2 tertiary university centers. Patients were divided into an upfront resection group (n = 394) and a neoadjuvant group (n = 152).
RESULTS
Tumor recurrence was significantly less common in pN0 patients as compared with pN1 patients, (upfront surgery: 55% vs. 77%, P < 0.001 and 64% vs. 78%, P = 0.040 in the neoadjuvant group). In addition, time to recurrence was significantly longer in pN0 versus pN1 patients in the upfront resected patients (median 16 mo pN0 vs. 10 mo pN1 P < 0.001), and the neoadjuvant group (pN0 21 mo vs. 11 mo pN1, P < 0.001). Of the patients who recurred, 62% presented with distant metastases (63% of pN0 and 62% of pN1, P = 0.553), 24% with local disease (27% of pN0 and 23% of pN1, P = 0.672) and 14% with synchronous local and distant disease (10% of pN0 and 15% of pN1, P = 0.292). Similarly, there was no difference in recurrence patterns between pN0 and pN1 in the neoadjuvant group, in which 68% recurred with distant metastases (76% of pN0 and 64% of pN1, P = 0.326) and 18% recurred with local disease (pN0: 22% and pN1: 15%, P = 0.435).
CONCLUSION
Time to recurrence was significantly longer for pN0 patients. However, patterns of recurrence for pN0 vs. pN1 patients were identical. Lymph node status was predictive of time to recurrence, but not location of recurrence.
目的
我们旨在评估淋巴结阴性（pN0）或阳性（pN1）的手术切除胰腺导管腺癌（PDAC）患者的复发模式。
摘要背景数据
预计到 2030 年，胰腺癌将成为第二大癌症死亡原因。这主要是由于早期局部和远处转移，即使在手术后也是如此。了解不同患者人群的复发模式可能提供新的治疗途径。
方法
从 2 个三级大学中心收集了 2005 年至 2016 年间接受 PDAC 切除术的 546 名患者的临床病理数据。患者分为直接手术组（n = 394）和新辅助治疗组（n = 152）。
结果
与 pN1 患者相比，pN0 患者的肿瘤复发明显较少（直接手术组：55% vs. 77%，P < 0.001 和 64% vs. 78%，P = 0.040；新辅助治疗组）。此外，在直接手术切除的患者中，pN0 患者的复发时间明显长于 pN1 患者（中位 pN0 为 16 个月，pN1 为 10 个月，P < 0.001），新辅助治疗组为（pN0 为 21 个月，pN1 为 11 个月，P < 0.001）。在复发的患者中，62%出现远处转移（pN0 为 63%，pN1 为 62%，P = 0.553），24%出现局部疾病（pN0 为 27%，pN1 为 23%，P = 0.672），14%出现同步局部和远处疾病（pN0 为 10%，pN1 为 15%，P = 0.292）。同样，新辅助治疗组中 pN0 和 pN1 之间的复发模式也没有差异，其中 68%的患者出现远处转移（pN0 为 76%，pN1 为 64%，P = 0.326），18%的患者出现局部疾病（pN0 为 22%，pN1 为 15%，P = 0.435）。
结论
pN0 患者的复发时间明显更长。然而，pN0 与 pN1 患者的复发模式相同。淋巴结状态可预测复发时间，但不能预测复发部位。
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