局部治疗（包括胰切除术）在孤立性同步肝转移的胰腺导管腺癌患者中的作用：倾向评分匹配分析。

The role of local treatment including pancreatectomy for pancreatic ductal adenocarcinoma patients with isolated synchronous liver metastasis: Propensity score-matched analyses.

机构信息

Department of Surgery and Cancer Research Institute, Seoul National University College of medicine, Seoul, Korea.

Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.

出版信息

J Hepatobiliary Pancreat Sci. 2023 Aug;30(8):1036-1045. doi: 10.1002/jhbp.1313. Epub 2023 Feb 27.

DOI:10.1002/jhbp.1313

PMID:36734117

Abstract

BACKGROUND

In an era of more effective chemotherapy for pancreatic ductal adenocarcinoma (PDAC), the paradigm of local treatment is changing. However, the efficacy of local treatment in patients with isolated liver metastasis remains unclear. Therefore, we aimed to evaluate the effectiveness of pancreatectomy ± local treatment for metastasis (cytoreductive surgery) in PDAC patients with isolated synchronous liver metastasis.

METHODS

In total, 239 patients with isolated liver metastasis were extracted from Seoul National University Hospital (SNUH). For comparison, another 12 637 patients were extracted from the National Cancer Database (NCDB). Propensity score matching was performed to minimize confounding in both cohorts. Survival analyses stratified by the treatment delivered were performed using Kaplan-Meier estimates and log-rank tests.

RESULTS

In the SNUH cohort, the median (interquartile range) survival was 20.5 (13.0-42.0) months for patients who underwent cytoreductive surgery plus chemotherapy versus 12.0 (10.0-18.0) months for those who received chemotherapy alone (P < .001). With the NCDB cohort, the median (interquartile range) survival was 15.6 (8.9-31.2) months for patients who underwent cytoreductive surgery plus chemotherapy versus 7.4 (3.4-13.2) months for those who received chemotherapy alone (P < .001).

CONCLUSION

Patients with isolated synchronous liver metastasis should be considered for cytoreductive surgery in addition to effective chemotherapy.

摘要

背景

在胰腺癌（PDAC）化疗效果更佳的时代，局部治疗模式正在发生变化。然而，孤立性肝转移患者的局部治疗效果仍不清楚。因此，我们旨在评估胰腺切除术±局部治疗（细胞减灭术）对孤立性同步肝转移 PDAC 患者的疗效。

方法

共从首尔国立大学医院（SNUH）提取了 239 例孤立性肝转移患者。为了进行比较，还从国家癌症数据库（NCDB）中提取了 12637 例患者。在两个队列中均进行倾向评分匹配以最小化混杂因素。使用 Kaplan-Meier 估计和对数秩检验对按治疗方式分层的生存分析。

结果

在 SNUH 队列中，接受细胞减灭术联合化疗的患者的中位（四分位距）生存时间为 20.5（13.0-42.0）个月，而单独接受化疗的患者为 12.0（10.0-18.0）个月（P<0.001）。在 NCDB 队列中，接受细胞减灭术联合化疗的患者的中位（四分位距）生存时间为 15.6（8.9-31.2）个月，而单独接受化疗的患者为 7.4（3.4-13.2）个月（P<0.001）。