Yun Won-Gun, Kwon Wooil, Han Youngmin, Sohn Hee Ju, Kim Hyeong Seok, Lee Mirang, Kim Hongbeom, Thomas Alexander S, Kluger Michael D, Jang Jin-Young
Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, 101 Daehak-ro, Chongno-gu, Seoul 03080, Korea.
Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA.
Cancers (Basel). 2022 Apr 20;14(9):2067. doi: 10.3390/cancers14092067.
In the era of effective chemotherapy on pancreatic ductal adenocarcinoma (PDAC) with distant metastasis, data on the effects of metastatectomy are lacking. So, we investigated the effect of metastatectomy on survival after metastasis in PDAC patients with isolated lung metastasis. This retrospective study analyzed 1342 patients who were histologically diagnosed with PDAC with distant metastasis from January 2007 to December 2018, of which 83 patients had isolated pulmonary metastasis. Additionally, 4263 patients were extracted from the National Cancer Database (NCDB) and analyzed. Log-rank test and Kaplan−Meier survival analysis were used to analyze survival after metastasis. The five-year survival rate was significantly higher in patients who underwent pulmonary metastatectomy than in those who received only chemotherapy or supportive treatment (60.6% vs. 6.2% vs. 0.0%, p < 0.001). A similar trend was observed in the NCDB (two-year survival rate, 27.4% vs. 15.8% vs. 4.7%, p < 0.001). In the multivariate analysis, lung lesion multiplicity (hazard ratio (HR) = 2.004, p = 0.017), metastatectomy (HR = 0.278, p = 0.036), chemotherapy (HR = 0.434, p = 0.024), and chemotherapy cycles (HR = 0.300, p < 0.001) had significant effects on survival. Metastatectomy with primary pancreatic lesions is recommended with effective chemotherapy in PDAC patients with isolated lung metastasis.
在胰腺导管腺癌（PDAC）发生远处转移且有有效化疗方案的时代，关于转移灶切除术效果的数据尚缺。因此，我们研究了转移灶切除术对孤立性肺转移的PDAC患者转移后生存的影响。这项回顾性研究分析了2007年1月至2018年12月间1342例经组织学诊断为伴有远处转移的PDAC患者，其中83例有孤立性肺转移。此外，从国家癌症数据库（NCDB）中提取并分析了4263例患者。采用对数秩检验和Kaplan-Meier生存分析来分析转移后的生存情况。接受肺转移灶切除术的患者五年生存率显著高于仅接受化疗或支持治疗的患者（60.6%对6.2%对0.0%，p<0.001）。在NCDB中也观察到类似趋势（两年生存率，27.4%对15.8%对4.7%，p<0.001）。在多变量分析中，肺部病变的多发性（风险比（HR）=2.004，p=0.017）、转移灶切除术（HR=0.278，p=0.036）、化疗（HR=0.434，p=0.024）和化疗周期（HR=0.300，p<0.001）对生存有显著影响。对于孤立性肺转移的PDAC患者，建议在有效化疗的同时进行原发性胰腺病变的转移灶切除术。
