Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Pancreatology. 2021 Jan;21(1):130-137. doi: 10.1016/j.pan.2020.11.026. Epub 2020 Dec 4.
Previous studies on borderline resectable (BR) pancreatic cancer (PC) included patients with heterogenous preoperative states; however, the definition of resectability for PC has evolved. We aimed to investigate the prognostic factors for PC other than anatomical resectability in those who underwent upfront resection and discuss the optimal treatment strategy for PC.
We retrospectively examined 431 patients who underwent upfront surgery with curative intent between 2007 and 2014. The association between clinical characteristics and survival outcomes was assessed by stratifying patients according to risk factors. The patients were categorized into four groups based on anatomical (resectable [R]/BR) and biological features (CA19-9 ≤500/>500 U/mL): anatomical R with CA19-9 ≤500 U/mL (favorable-R); anatomical BR with CA19-9 ≤500 U/mL (favorable-BR); anatomical R with CA19-9 >500 U/mL (risky-R); and anatomical BR with CA19-9 >500 U/mL (risky-BR).
Overall, 320 and 111 patients had anatomical R- and BR-PC, respectively. A modified Glasgow prognostic score = 2 (hazard ratio [HR]: 1.73), NLR>5 (hazard ratio [HR]: 1.54), CA19-9 >500 U/mL (HR: 1.86), and anatomical BR (HR: 1.38) were independent prognostic factors for overall survival. The risky-R group had likely worse prognosis (16 months vs. 19 months, P = 0.0605) and a significantly higher early recurrence rate (36% vs 18%, P = 0.0231) than the favorable-BR group.
It is essential to stratify and distinguish PC patients at a high risk of worse prognosis. Risky-R was an unfavorable prognostic factor and should thus be considered in the decision-making for treatment with neoadjuvant chemotherapy, in addition to anatomical BR-PC.
先前关于局部可切除（BR）胰腺癌（PC）的研究纳入了术前状态存在异质性的患者；然而，PC 的可切除性定义已经发生了演变。我们旨在研究那些接受直接切除术的患者中除解剖可切除性以外的 PC 的预后因素，并讨论 PC 的最佳治疗策略。
我们回顾性分析了 2007 年至 2014 年间接受根治性直接手术的 431 例患者。根据风险因素对患者进行分层，评估临床特征与生存结果之间的相关性。根据解剖学（可切除[R]/BR）和生物学特征（CA19-9≤500/>500 U/mL），将患者分为四组：CA19-9≤500 U/mL 的解剖学 R 组（有利-R）；CA19-9≤500 U/mL 的解剖学 BR 组（有利-BR）；CA19-9>500 U/mL 的解剖学 R 组（风险-R）；和 CA19-9>500 U/mL 的解剖学 BR 组（风险-BR）。
总体而言，320 例患者为解剖学 R-PC，111 例患者为 BR-PC。改良格拉斯哥预后评分=2（风险比[HR]：1.73）、NLR>5（风险比[HR]：1.54）、CA19-9>500 U/mL（HR：1.86）和解剖学 BR（HR：1.38）是总生存的独立预后因素。风险-R 组的预后可能更差（16 个月 vs. 19 个月，P=0.0605），且早期复发率显著更高（36% vs. 18%，P=0.0231），与有利-BR 组相比。
对预后较差风险较高的 PC 患者进行分层和区分至关重要。风险-R 是一个不利的预后因素，因此除了 BR-PC 外，在决定是否采用新辅助化疗治疗时也应考虑这一因素。
