Pausch Thomas M, Liu Xinchun, Cui Jiaqu, Wei Jishu, Miao Yi, Heger Ulrike, Probst Pascal, Heap Stephen, Hackert Thilo
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Cancers (Basel). 2021 Dec 23;14(1):57. doi: 10.3390/cancers14010057.
Guidelines do not recommend resection surgery for oligometastatic pancreatic ductal adenocarcinoma (PDAC). However, reports in small samples of selected patients suggest that surgery extends survival. Thus, this study aims to gather evidence for the benefits of cancer-directed surgery (CDS) by analyzing a national cohort and identifying prognostic factors that aid the selection of candidates for CDS or recruitment into experimental trials. Data for patients with PDAC and hepatic metastasis were extracted from the population-based Surveillance, Epidemiology, and End Results database (SEER). The bias between CDS and non-CDS groups was minimized with Propensity Score Matching (PSM), and the prognostic role of CDS was investigated by comparing Kaplan-Meier estimators and Cox proportional hazard models. A total of 12,018 patients were extracted from the database, including 259 patients who underwent CDS that were 1:1 propensity score-matched with patients who did not receive CDS. CDS appeared to significantly prolong median overall survival from 5 to 10 months. Multivariate analysis revealed chemotherapy as a protective prognostic, whilst survival was impaired by old age and tumors that were poorly differentiated (Grades III-IV). These factors can be used to select patients likely to benefit from CDS treatment, which may facilitate recruitment into randomized controlled trials.
指南不推荐对寡转移性胰腺导管腺癌（PDAC）进行切除手术。然而，对部分选定患者的小样本报告表明，手术可延长生存期。因此，本研究旨在通过分析全国队列并确定有助于选择癌症定向手术（CDS）候选者或纳入试验性试验的预后因素，来收集CDS益处的证据。从基于人群的监测、流行病学和最终结果数据库（SEER）中提取了患有PDAC和肝转移患者的数据。通过倾向得分匹配（PSM）将CDS组和非CDS组之间的偏差降至最低，并通过比较Kaplan-Meier估计值和Cox比例风险模型来研究CDS的预后作用。从数据库中总共提取了12018名患者，其中包括259名接受CDS的患者，这些患者与未接受CDS的患者进行了1:1倾向得分匹配。CDS似乎显著将中位总生存期从5个月延长至10个月。多变量分析显示化疗是一种保护性预后因素，而老年和低分化肿瘤（III-IV级）会损害生存期。这些因素可用于选择可能从CDS治疗中获益的患者，这可能有助于纳入随机对照试验。
