Einama Takahiro, Takihata Yasuhiro, Aosasa Suefumi, Konno Fukumi, Kobayashi Kazuki, Yonamine Naoto, Fujinuma Ibuki, Tsunenari Takazumi, Nakazawa Akiko, Shinto Eiji, Ueno Hideki, Kishi Yoji
Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan.
Departmetn of Surgery, Shinkuki General Hospital, Sasitama 346-0021, Japan.
Cancers (Basel). 2023 Feb 9;15(4):1101. doi: 10.3390/cancers15041101.
Although conversion surgery has increasingly been performed for initially unresectable advanced pancreatic ductal adenocarcinoma (PDAC), the rate of conversion, including that for patients who do not undergo resection, remains unclear. Patients with PDAC who were treated between January 2013 and December 2018 were classified into three groups: resectable (R), borderline resectable (BR), and unresectable (UR). We analyzed patient outcomes, including the rate of surgical resection and survival, in each of these groups. In total, 211 patients (R, 118; BR, 22; UR, 81) were selected. Among them, 117 (99%), 18 (82%), and 15 (19%) patients in the R, BR, and UR groups, respectively, underwent surgical resection. R0 resection rates were 88, 78, and 67%, whereas median overall survival (OS) from treatment initiation were 31, 18, and 11 months ( < 0.0001) in the R, BR, and UR groups, respectively. In patients who underwent surgical resection, relapse-free survival (RFS) and OS were similar among the three groups (R vs. BR vs. UR; median RFS (months), 17 vs. 13 vs. 11, = 0.249; median OS (months), 31 vs. 26 vs. 32, = 0.742). Lymph node metastases and incomplete adjuvant chemotherapy were identified as independent prognostic factors for OS. Although the surgical resection rate was low, particularly in the BR and UR groups, the prognosis of patients who underwent surgical resection was similar irrespective of the initial resectability status.
尽管对于最初无法切除的晚期胰腺导管腺癌（PDAC），转化手术的开展越来越多，但包括未接受切除术患者在内的转化率仍不明确。2013年1月至2018年12月期间接受治疗的PDAC患者被分为三组：可切除（R）组、临界可切除（BR）组和不可切除（UR）组。我们分析了每组患者的手术切除率和生存率等预后情况。总共选取了211例患者（R组118例、BR组22例、UR组81例）。其中，R组、BR组和UR组分别有117例（99%）、18例（82%）和15例（19%）患者接受了手术切除。R0切除率分别为88%、78%和67%，而从开始治疗起的中位总生存期（OS）在R组、BR组和UR组分别为31个月、18个月和11个月（<0.0001）。在接受手术切除的患者中，三组的无复发生存期（RFS）和OS相似（R组 vs. BR组 vs. UR组；中位RFS（月），17 vs. 13 vs. 11，P = 0.249；中位OS（月），31 vs. 26 vs. 32，P = 0.742）。淋巴结转移和辅助化疗不完整被确定为OS的独立预后因素。尽管手术切除率较低，尤其是在BR组和UR组，但无论初始可切除状态如何，接受手术切除患者的预后相似。
