Malleo Giuseppe, Salvia Roberto, Maggino Laura, Marchegiani Giovanni, D'Angelica Michael, DeMatteo Ronald, Kingham Peter, Pulvirenti Alessandra, Sereni Elisabetta, Jarnagin William R, Bassi Claudio, Allen Peter J, Butturini Giovanni
Unit of General and Pancreatic Surgery-DSCOMI University of Verona, Verona, Italy.
Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy.
Ann Surg Oncol. 2021 Jun;28(6):3100-3108. doi: 10.1245/s10434-021-09649-w. Epub 2021 Feb 11.
Pancreatic metastases (PM) from renal cell carcinoma (RCC) are uncommon. We herein describe the long-term outcomes associated with pancreatectomy at two academic institutions, with a specific focus on 10-year survival.
This investigation was limited to patients undergoing pancreatectomy for PM between 2000 and 2008 at the University of Verona and Memorial Sloan Kettering Cancer Center, allowing a potential for 10 years of surveillance. The probabilities of further RCC recurrence and RCC-related death were estimated using a competing risk analysis (method of Fine and Gray) to account for patients who died of other causes during follow-up.
The study population consisted of 69 patients, mostly with isolated metachronous PM (77%). The median interval from nephrectomy to pancreatic metastasectomy was 109 months, whereas the median post-pancreatectomy follow-up was 141 months. The 10-year cumulative incidence of new RCC recurrence was 62.7%. In the adjusted analysis, the relative risk of repeated recurrence was significantly higher in PM synchronous to the primary RCC (sHR = 1.27) and in patients receiving extended pancreatectomy (sHR = 3.05). The 10-year cumulative incidence of disease-specific death was 25.5%. The only variable with an influence on disease-specific death was the recurrence-free interval following metastasectomy (sHR = 0.98). In patients with repeated recurrence, the 10-year cumulative incidence of RCC-related death was 35.4%.
In a selected group of patients followed for a median of 141 months and mostly with isolated metachronous PM, resection was associated with a high possibility of long-term disease control in surgically fit patients with metastases confined to the pancreas.
肾细胞癌（RCC）的胰腺转移（PM）并不常见。我们在此描述了两家学术机构中与胰腺切除术相关的长期预后，特别关注10年生存率。
本研究仅限于2000年至2008年期间在维罗纳大学和纪念斯隆凯特琳癌症中心接受胰腺转移瘤切除术的患者，随访时间长达10年。使用竞争风险分析（Fine和Gray方法）估计RCC进一步复发和RCC相关死亡的概率，以考虑随访期间死于其他原因的患者。
研究人群包括69例患者，大多数为孤立性异时性PM（77%）。从肾切除术到胰腺转移瘤切除术的中位间隔时间为109个月，而胰腺切除术后的中位随访时间为141个月。新的RCC复发的10年累积发生率为62.7%。在调整分析中，与原发性RCC同时发生的PM患者（sHR = 1.27）和接受扩大胰腺切除术的患者（sHR = 3.05）再次复发的相对风险显著更高。疾病特异性死亡的10年累积发生率为25.5%。对疾病特异性死亡有影响的唯一变量是转移瘤切除术后的无复发生存期（sHR = 0.98）。在复发的患者中，RCC相关死亡的10年累积发生率为35.4%。
在一组中位随访时间为141个月且大多数为孤立性异时性PM的选定患者中，对于转移局限于胰腺且手术适合的患者，手术切除与长期疾病控制的高可能性相关。
