切除胰腺腺癌后的病理升级：危险因素和对生存的影响。
Pathologic upstaging in resected pancreatic adenocarcinoma: Risk factors and impact on survival.
机构信息
Department of Surgery, College of Medicine, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
Program for Liver, Pancreas, & Foregut Tumors, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.
出版信息
J Surg Oncol. 2021 Jul;124(1):79-87. doi: 10.1002/jso.26481. Epub 2021 Apr 9.
BACKGROUND
Clinical and pathologic staging determine treatment of pancreatic cancer. Clinical stage has been shown to underestimate final pathologic stage in pancreatic cancer, resulting in upstaging.
METHODS
National Cancer Database was used to identify clinical stage I pancreatic adenocarcinoma. Univariate, multivariable logistic regression, and Cox proportional hazard ratio were used to determine differences between upstaged and stage concordant patients.
RESULTS
Upstaging was seen in 80.2% of patients. Factors found to be significantly associated with upstaging included pancreatic head tumors (OR 2.56), high-grade histology (OR 1.74), elevated Ca 19-9 (OR 2.09), and clinical stage T2 (OR 1.99). Upstaging was associated with a 45% increased risk of mortality compared to stage concordant disease (HR 1.44, p < .001).
CONCLUSION
A majority of clinical stage I pancreatic cancer is upstaged after resection. Factors including tumor location, grade, Ca 19-9, and tumor size can help identify those at high risk for upstaging.
背景
临床和病理分期决定了胰腺癌的治疗方法。临床分期已被证明低估了胰腺癌的最终病理分期，导致分期过高。
方法
国家癌症数据库用于确定临床 I 期胰腺腺癌。采用单因素、多因素逻辑回归和 Cox 比例风险比来确定分期过高和分期一致的患者之间的差异。
结果
80.2%的患者出现分期过高。与分期过高显著相关的因素包括胰头部肿瘤（OR 2.56）、高级别组织学（OR 1.74）、CA 19-9 升高（OR 2.09）和临床 T2 期（OR 1.99）。与分期一致的疾病相比，分期过高患者的死亡率增加了 45%（HR 1.44，p<0.001）。
结论
大多数临床 I 期胰腺癌在切除后分期过高。肿瘤位置、分级、CA 19-9 和肿瘤大小等因素有助于识别那些分期过高风险较高的患者。
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