评估ⅠA 期胰腺导管腺癌患者辅助化疗的意义。

Evaluation of the significance of adjuvant chemotherapy in patients with stage ⅠA pancreatic ductal adenocarcinoma.

机构信息

Department of Surgery, Institute of Gastroenterology, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

出版信息

Pancreatology. 2021 Apr;21(3):581-588. doi: 10.1016/j.pan.2021.01.024. Epub 2021 Feb 5.

DOI:10.1016/j.pan.2021.01.024

PMID:33579600

Abstract

BACKGROUND

Although adjuvant chemotherapy is considered a standard treatment for resected pancreatic ductal adenocarcinoma (PDAC), its utility in stage ⅠA patients is unclear. We aimed to investigate the recurrence rate, surgical outcome, prognostic factors, effectiveness of adjuvant chemotherapy, and determination of groups in whom adjuvant chemotherapy is effective in patients with stage ⅠA PDAC.

METHODS

We retrospectively analyzed 73 patients who underwent pancreatectomy and were pathologically diagnosed with stage ⅠA PDAC between 2000 and 2018. We evaluated the relation between clinicopathological factors, recurrence rates, and outcomes such as the recurrence-free and disease-specific survival rates (RFS and DSS, respectively).

RESULTS

The 5-year RFS and DSS rates were 52% and 58%, respectively. In multivariate analysis, a platelet-to-lymphocyte ratio (PLR) ≥ 170, prognostic nutrition index (PNI) < 47.5, and pathological grade 2 or 3 constituted risk factors for a shorter DSS (hazard ratios: 4.7, 4.6, and 4.1, respectively). Patients with 0-1 of these risk factors (low-risk group; n = 47) had significantly higher 5-year DSS rates than those with 2-3 risk factors (high-risk group; n = 26) (80% vs. 23%; P < 0.001). Patients in the low-risk group showed similar 5-year RFS rates regardless of whether they received or not adjuvant chemotherapy (75% vs 70%, respectively; P = 0.49). Contrarily, high-risk patients who underwent adjuvant chemotherapy had higher 5-year RFS rates than those who did not receive adjuvant chemotherapy (32% vs 0%; P = 0.045).

CONCLUSIONS

In stage IA PDAC, adjuvant chemotherapy seems to be effective only in a subgroup of high-risk patients.

摘要

背景

尽管辅助化疗被认为是可切除胰腺导管腺癌（PDAC）的标准治疗方法，但在ⅠA 期患者中的应用尚不清楚。我们旨在研究ⅠA 期 PDAC 患者的复发率、手术结果、预后因素、辅助化疗的有效性以及确定辅助化疗有效的患者群体。

方法

我们回顾性分析了 2000 年至 2018 年间接受胰腺切除术且病理诊断为ⅠA 期 PDAC 的 73 例患者。我们评估了临床病理因素与复发率以及无复发生存率（RFS）和疾病特异性生存率（DSS）等结局之间的关系。

结果

5 年 RFS 和 DSS 率分别为 52%和 58%。多因素分析显示，血小板与淋巴细胞比值（PLR）≥170、预后营养指数（PNI）<47.5 和病理分级 2 或 3 是 DSS 较短的危险因素（危险比分别为 4.7、4.6 和 4.1）。0-1 个这些危险因素的患者（低危组；n=47）的 5 年 DSS 率显著高于 2-3 个危险因素的患者（高危组；n=26）（80% vs. 23%；P<0.001）。无论是否接受辅助化疗，低危组患者的 5 年 RFS 率相似（分别为 75%和 70%；P=0.49）。相反，接受辅助化疗的高危患者的 5 年 RFS 率高于未接受辅助化疗的患者（32% vs. 0%；P=0.045）。