Sung Min Kyu, Park Yejong, Kwak Bong Jun, Jun Eunsung, Lee Woohyung, Song Ki Byung, Lee Jae Hoon, Hwang Dae Wook, Kim Song Cheol
Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea.
Convergence Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea.
Biomedicines. 2021 Nov 17;9(11):1706. doi: 10.3390/biomedicines9111706.
The impact of tumor location on patient survival in pancreatic ductal adenocarcinoma (PDAC) remains controversial. This study investigated the association between primary tumor location and survival rates for resectable PDAC. Additionally, we assessed if this association remains consistent across categories of the Tumor-Node-Metastasis staging system. We analyzed 2471 patients who underwent surgical resection between 2000 and 2018 at a single center. Subgroup analysis was performed according to the Tumor-Node-Metastasis staging system. Among the group, 67.9% (1677 patients) had pancreatic head cancer (PHC) and 32.1% (794 patients) had pancreatic body/tail cancer (PBTC). Patients with PHC had worse overall survival and worse disease-free survival than those with PBTC. Patients with PHC had worse survival in stage IB and stage IIB than those with PBTC. No significant difference was observed for stages IA, IIA, and III. Multivariate analysis showed that elevated CA 19-9, mGPS, a longer hospital stay, complication, accompanying vein resection, larger tumor size, worse differentiation, higher TNM stage (stage IIB, III, IV), presence of LVI, and positive resection margin were risk factors for poor survival after resection. In resectable PDAC, patients with PHC had worse overall and disease-free survival than those with PBTC. However, tumor location was not an independent prognostic factor for PDAC.
肿瘤位置对胰腺导管腺癌（PDAC）患者生存率的影响仍存在争议。本研究调查了可切除性PDAC的原发肿瘤位置与生存率之间的关联。此外，我们评估了这种关联在肿瘤-淋巴结-转移（TNM）分期系统的各个类别中是否保持一致。我们分析了2000年至2018年在单一中心接受手术切除的2471例患者。根据TNM分期系统进行亚组分析。在该组中，67.9%（1677例患者）患有胰头癌（PHC），32.1%（794例患者）患有胰体/尾癌（PBTC）。PHC患者的总生存期和无病生存期均比PBTC患者差。PHC患者在IB期和IIB期的生存期比PBTC患者差。IA期、IIA期和III期未观察到显著差异。多因素分析显示，CA 19-9升高、改良格拉斯哥预后评分（mGPS）、住院时间延长、并发症、伴行静脉切除、肿瘤体积较大、分化较差、TNM分期较高（IIB期、III期、IV期）、存在淋巴管侵犯（LVI）和切缘阳性是切除术后生存不良的危险因素。在可切除性PDAC中，PHC患者的总生存期和无病生存期比PBTC患者差。然而，肿瘤位置不是PDAC的独立预后因素。
