Xu Dongni, Wang Jiangling, Liu Ting, Huang Zhuoshan, Luo Jianwei, Chen Yuqing, Lu Yanan
Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Anesthesiology, Cancer Hospital of Chinese Academy of Sciences, Hangzhou, China.
Gland Surg. 2021 Feb;10(2):770-779. doi: 10.21037/gs-20-877.
Pancreatic ductal adenocarcinoma (PDAC) is one of malignant tumors with the worst prognosis. Surgery and adjuvant chemotherapy are the main treatments for resectable pancreatic cancer. For borderline resectable PDAC, neoadjuvant chemotherapy has been advised. For clearly resectable PDAC, neoadjuvant chemotherapy also might be considered for the patients with high-risk features, but with no precise quantitative criteria to define these features. So, this study aimed to re-evaluate the relationship between high-risk features and prognosis of clearly resectable pancreatic cancer, and to define the precise criteria for these high-risk features.
Data from 211 patients with clearly resectable pancreatic cancer were reviewed to assess the relationship between overall survival (OS) after surgery and high-risk features, and cut-off values were determined for high-risk features that were associated with poor prognosis of clearly resectable pancreatic cancer.
Lymph node metastasis (LNM), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and primary tumor size ≥6 cm were significant variables related to OS. CA19-9 ≥1,000 U/mL was statistically related to prognosis, as was CA19-9 ≥500 U/mL without obstructive jaundice. There was no significant relationship between abdominal and/or back pain and OS, but patients with moderate or severe pain accompanied by tumor size ≥4 cm or 10 times higher CA19-9 levels had worse prognosis.
For clearly resectable pancreatic cancer with R0 resection, the high-risk features were clarified. Abdominal and/or back pain may not be used as a prognostic indicator alone, though combined with CA19-9 or tumor size it may be more valuable for predicting prognosis.
胰腺导管腺癌（PDAC）是预后最差的恶性肿瘤之一。手术和辅助化疗是可切除胰腺癌的主要治疗方法。对于临界可切除的PDAC，建议进行新辅助化疗。对于明确可切除的PDAC，具有高危特征的患者也可考虑新辅助化疗，但尚无精确的定量标准来定义这些特征。因此，本研究旨在重新评估明确可切除胰腺癌高危特征与预后之间的关系，并确定这些高危特征的精确标准。
回顾211例明确可切除胰腺癌患者的数据，以评估术后总生存期（OS）与高危特征之间的关系，并确定与明确可切除胰腺癌预后不良相关的高危特征的临界值。
淋巴结转移（LNM）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）以及原发肿瘤大小≥6 cm是与OS相关的显著变量。CA19-9≥1000 U/mL与预后具有统计学相关性，无梗阻性黄疸时CA19-9≥500 U/mL也与预后相关。腹痛和/或背痛与OS之间无显著关系，但伴有肿瘤大小≥4 cm或CA19-9水平高出10倍的中度或重度疼痛患者预后较差。
对于行R0切除的明确可切除胰腺癌，明确了高危特征。腹痛和/或背痛可能不能单独用作预后指标，不过与CA19-9或肿瘤大小结合起来可能对预测预后更有价值。
