Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur J Surg Oncol. 2022 May;48(5):1062-1067. doi: 10.1016/j.ejso.2021.11.135. Epub 2021 Dec 2.
Surgical resection is recommended for patients with resectable acinar cell carcinoma (ACC). The aim of this study was to investigate the clinical characteristics and surgical outcomes of resectable ACC in comparison to pancreatic ductal adenocarcinoma (PDAC).
A retrospective analysis was performed on all patients who consecutively underwent radical resection with pathologically confirmed ACC and PDAC from December 2011 to December 2018. Clinicopathologic characteristics and follow-up information were analyzed. A 1:3 propensity score matching (PSM) method was used to minimize the bias between ACC and PDAC.
A total of 26 patients with ACC and 1351 with PDAC were included. Compared to PDAC, ACC tended to be larger (4.5 vs. 3.0 cm; p < 0.001) and more frequently located in the pancreatic body/tail (61.5% vs. 36.6%, p = 0.009), with lower total bilirubin levels, lower neutrophil lymphocyte ratio (NLR) levels and lower carbohydrate antigen 19-9 (CA19-9) levels and carcinoembryonic antigen (CEA) levels. There was no difference in postoperative morbidities in patients with ACC and PDAC. The median OS and RFS were longer in ACC when compared to PDAC (OS: 43.5 mo vs. 19.0 mo, p = 0.004; RFS: 24.5 mo vs. 11.6 mo, p = 0.023). After the 1:3 PSM, ACC remained to be a better histological type for OS (p = 0.024), but had comparable RFS with PDAC (p = 0.164).
Patients with ACC after radical resection had better OS than that with PDAC. However, ACC is also an aggressive tumor with a similar trend of RFS with PDAC after the matching, necessitating the multidisciplinary treatment for resectable ACC disease.
对于可切除的腺泡细胞癌（ACC）患者，推荐进行手术切除。本研究旨在比较可切除的 ACC 和胰腺导管腺癌（PDAC）患者的临床特征和手术结果。
对 2011 年 12 月至 2018 年 12 月连续接受根治性切除术且病理证实为 ACC 和 PDAC 的所有患者进行回顾性分析。分析临床病理特征和随访信息。采用 1:3 倾向评分匹配（PSM）方法以最小化 ACC 和 PDAC 之间的偏倚。
共纳入 26 例 ACC 患者和 1351 例 PDAC 患者。与 PDAC 相比，ACC 肿瘤往往更大（4.5 厘米 vs. 3.0 厘米；p<0.001），更常位于胰体/胰尾（61.5% vs. 36.6%，p=0.009），总胆红素水平更低，中性粒细胞与淋巴细胞比值（NLR）水平更低，癌胚抗原（CEA）和碳水化合物抗原 19-9（CA19-9）水平更低。ACC 患者与 PDAC 患者的术后并发症发生率无差异。与 PDAC 相比，ACC 患者的中位 OS 和 RFS 更长（OS：43.5 个月 vs. 19.0 个月，p=0.004；RFS：24.5 个月 vs. 11.6 个月，p=0.023）。在 1:3 PSM 后，ACC 仍然是 OS 的更好的组织学类型（p=0.024），但与 PDAC 的 RFS 无差异（p=0.164）。
根治性切除后，ACC 患者的 OS 优于 PDAC 患者。然而，ACC 也是一种侵袭性肿瘤，在匹配后与 PDAC 的 RFS 趋势相似，因此需要对可切除的 ACC 疾病进行多学科治疗。
