Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Jiao Tong University School of Medicine, Research Institute of Pancreatic Disease, Shanghai, China.
Cancer Med. 2021 Sep;10(17):5948-5963. doi: 10.1002/cam4.4147. Epub 2021 Jul 21.
Primary tumor resection (PTR) as a treatment option for patients with stage IV pancreatic cancer (PC) is controversial.
Stage IV PC patients, with treatment data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER), were screened. The main outcomes were overall survival (OS) and cancer-specific survival (CSS).
We enrolled 15,836 stage IV PC patients in this study. Propensity score-matched analyses revealed improved OS and CSS of patients receiving chemotherapy plus PTR versus chemotherapy (median survival time [MST ]: 13 vs. 9 months, p = 0.024; MST : 14 vs. 10 months, p = 0.035), and chemoradiotherapy plus PTR versus chemoradiotherapy (MST : 14 vs. 7 months, p = 0.044; MST : 14 vs. 7 months, p = 0.066). Multivariate adjusted analyses further confirmed these results. Stratified with different metastatic modalities, multivariate analyses suggested that PTR significantly improved the OS and CSS among patients with ≤1 metastatic organ, and that patients with brain metastasis might not benefit from chemotherapy treatment.
PTR improves the OS and CSS of stage IV PC patients on the basis of chemotherapy or chemoradiotherapy, provided that the metastases involve ≤1 organ. Chemotherapy, however, should be carefully considered in patients with metastases involving the brain.
对于 IV 期胰腺癌（PC）患者，作为治疗选择的原发肿瘤切除术（PTR）存在争议。
筛选了来自美国国家癌症研究所的监测、流行病学和最终结果（SEER）的 IV 期 PC 患者的治疗数据。主要结局为总生存期（OS）和癌症特异性生存期（CSS）。
本研究共纳入 15836 例 IV 期 PC 患者。倾向评分匹配分析显示，接受化疗加 PTR 的患者的 OS 和 CSS 优于接受化疗的患者（中位生存时间[MST]：13 个月比 9 个月，p=0.024；MST：14 个月比 10 个月，p=0.035），接受化疗加 PTR 的患者的 OS 和 CSS 也优于接受放化疗加 PTR 的患者（MST：14 个月比 7 个月，p=0.044；MST：14 个月比 7 个月，p=0.066）。多变量调整分析进一步证实了这些结果。分层分析不同转移方式，多变量分析表明，PTR 显著改善了转移器官≤1 个的患者的 OS 和 CSS，而脑转移的患者可能不能从化疗治疗中获益。
在化疗或放化疗的基础上进行 PTR 可提高 IV 期 PC 患者的 OS 和 CSS，但转移涉及≤1 个器官。然而，对于脑转移的患者，应慎重考虑化疗。
