Liang Yuexiang, Chang Shaofei, Guo Hanhan, Man Quan, Zang Fenglin, Gao Song
Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer Tianjin 300060, China.
Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University Haikou 570102, Hainan, China.
Am J Cancer Res. 2023 May 15;13(5):1970-1984. eCollection 2023.
Tumor deposits (TDs) are associated with poor prognosis in several malignancies and have been incorporated into the tumor-node-metastasis (TNM) staging system for colorectal cancer. This study aims to explore the significance of TDs in pancreatic ductal adenocarcinoma (PDAC). All patients who underwent pancreatectomy with a curative intent for PDAC were retrospectively enrolled. Patients were categorized into 2 groups according to the status of TDs: the positive group, in which TDs were present, and the negative group, in which TDs were absent. The prognostic significance of TDs was evaluated. In addition, a modified staging system was developed by incorporating TDs into the eighth edition of the TNM staging system. One hundred nine (17.8%) patients had TDs. Patients with TDs demonstrated significantly lower 5-year overall survival (OS) and recurrence-free survival (RFS) rates than those without TDs (OS: 9.1% 21.5%, =0.001; RFS: 6.1% 16.7%, <0.001). Even after matching, patients with TDs still had significantly worse OS and RFS than those without TDs. In the multivariate analysis, the presence of TDs was an independent prognostic factor in patients with PDAC. The survival of patients with TDs was similar to that of patients with N2 stage disease. The modified staging system had a greater Harrell's C-index than the TNM staging system, which indicates better performance in predicting survival. The presence of TDs was an independent prognostic factor for PDAC. Categorizing patients with TDs into N2 stage improved the accuracy of the TNM staging system in predicting prognosis.
肿瘤沉积物（TDs）在多种恶性肿瘤中与预后不良相关，并且已被纳入结直肠癌的肿瘤-淋巴结-转移（TNM）分期系统。本研究旨在探讨TDs在胰腺导管腺癌（PDAC）中的意义。对所有接受了旨在治愈PDAC的胰腺切除术的患者进行回顾性纳入。根据TDs的状态将患者分为两组：TDs存在的阳性组和TDs不存在的阴性组。评估TDs的预后意义。此外，通过将TDs纳入TNM分期系统的第八版，开发了一种改良的分期系统。109例（17.8%）患者有TDs。有TDs的患者的5年总生存率（OS）和无复发生存率（RFS）显著低于没有TDs的患者（OS：9.1%对21.5%，P=0.001；RFS：6.1%对16.7%，P<0.001）。即使在匹配后，有TDs的患者的OS和RFS仍显著差于没有TDs的患者。在多变量分析中，TDs的存在是PDAC患者的独立预后因素。有TDs的患者的生存率与N2期疾病患者的生存率相似。改良分期系统的Harrell's C指数高于TNM分期系统，这表明其在预测生存方面表现更好。TDs的存在是PDAC的独立预后因素。将有TDs的患者归类为N2期提高了TNM分期系统预测预后的准确性。
