不可切除胰腺导管腺癌转化手术的临床益处：单机构回顾性分析
Clinical Benefits of Conversion Surgery for Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Institution, Retrospective Analysis.
作者信息
Mataki Yuko, Kurahara Hiroshi, Idichi Tetsuya, Tanoue Kiyonori, Hozaka Yuto, Kawasaki Yota, Iino Satoshi, Maemura Kosei, Shinchi Hiroyuki, Ohtsuka Takao
机构信息
Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Kagoshima 890-8520, Japan.
Department of Digestive Surgery, Kagoshima Principal Hospital, Kagoshima 890-0055, Japan.
出版信息
Cancers (Basel). 2021 Mar 2;13(5):1057. doi: 10.3390/cancers13051057.
BACKGROUND
Unresectable pancreatic ductal adenocarcinoma (UR-PDAC) has a poor prognosis. Conversion surgery is considered a promising strategy for improving the prognosis of UR-PDAC. This study aimed to investigate the clinical benefits of conversion surgery in patients with UR-PDAC.
METHODS
We retrospectively evaluated patients with PDAC who were referred to our department for possible surgical resection between January 2006 and December 2019. Conversion surgery was performed only in patients with UR-PDAC who could expect R0 resection. We analyzed the prognostic factors for overall survival among patients who underwent conversion surgery.
RESULTS
Overall, 638 patients with advanced pancreatic cancer were enrolled in this study. According to resectability, resectable cancer (R) was present in 180 patients, borderline resectable cancer (BR) was present in 60 patients, unresectable locally advanced cancer (UR-LA) was present in 252 patients, and unresectable cancer with distant metastasis (UR-M) was present in 146 patients. Conversion surgery was performed in 20 of the 398 UR cases (5.1%). The median period between the initial therapy and conversion surgery was 15.5 months. According to the Response Evaluation Criteria in Solid Tumors (RECIST) evaluation, the treatment response was CR in one patient, PR in 13, SD in five, and PD in one. Downstaging was pathologically determined in all cases. According to the Evans grading system, grade I was observed in four patients (20%), grade IIb was observed in seven (35%), III was observed in seven (35%), and IV was observed in two (10%). We compared the overall survival period from initial treatment among patients undergoing conversion surgery; the median overall survival durations in the conversion surgery, R, BR, UR-LA, and UR-M groups were 73.7, 32.7, 22.7, 15.7, and 8.8 months, respectively. Multivariate analysis revealed that the presence or absence of chemoradiotherapy (CRT) and the RECIST partial response (PR)/complete response (CR) for the main tumor were statistically significant prognostic factors for overall survival among patients undergoing conversion surgery ( = 0.004 and 0.03, respectively).
CONCLUSION
In UR-PDAC, it is important to perform multidisciplinary treatment, including CRT with conversion surgery.
背景
不可切除的胰腺导管腺癌（UR-PDAC）预后较差。转化手术被认为是改善UR-PDAC预后的一种有前景的策略。本研究旨在探讨转化手术对UR-PDAC患者的临床益处。
方法
我们回顾性评估了2006年1月至2019年12月期间因可能行手术切除而转诊至我科的PDAC患者。仅对有望实现R0切除的UR-PDAC患者进行转化手术。我们分析了接受转化手术患者的总生存预后因素。
结果
总体而言，本研究共纳入638例晚期胰腺癌患者。根据可切除性，180例为可切除癌（R），60例为边缘可切除癌（BR），252例为不可切除的局部晚期癌（UR-LA），146例为伴有远处转移的不可切除癌（UR-M）。398例UR病例中有20例（5.1%）接受了转化手术。初始治疗与转化手术之间的中位时间为15.5个月。根据实体瘤疗效评价标准（RECIST）评估，治疗反应为1例完全缓解（CR），13例部分缓解（PR），5例疾病稳定（SD），1例疾病进展（PD）。所有病例均经病理确定分期降低。根据埃文斯分级系统，4例（20%）为I级，7例（35%）为IIb级，7例（35%）为III级，2例（10%）为IV级。我们比较了接受转化手术患者从初始治疗开始的总生存期；转化手术组、R组、BR组、UR-LA组和UR-M组的中位总生存期分别为73.7个月、32.7个月、22.7个月、15.7个月和8.8个月。多因素分析显示，是否接受放化疗（CRT）以及主要肿瘤的RECIST部分缓解（PR）/完全缓解（CR）是接受转化手术患者总生存的统计学显著预后因素（分别为 = 0.004和0.03）。
结论
在UR-PDAC中，进行包括CRT和转化手术在内的多学科治疗很重要。
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