Department of General Surgery, Cancer Center, Division of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
Department of Surgery, Qingdao University, Qingdao, China.
World J Surg Oncol. 2023 Jun 22;21(1):191. doi: 10.1186/s12957-023-03080-z.
Recurrence after resection is the main factor for poor survival. The relationship between clinicopathological factors and recurrence after curative distal pancreatectomy for PDAC has rarely been reported separately.
Patients with PDAC after left‑sided pancreatectomy between May 2015 and August 2021 were retrospectively identified.
One hundred forty-one patients were included. Recurrence was observed in 97 patients (68.8%), while 44 (31.2%) patients had no recurrence. The median RFS was 8.8 months. The median OS was 24.9 months. Local recurrence was the predominant first detected recurrence site (n = 36, 37.1%), closely followed by liver recurrence (n = 35, 36.1%). Multiple recurrences occurred in 16 (16.5%) patients, peritoneal recurrence in 6 (6.2%) patients, and lung recurrence in 4 (4.1%) patients. High CA19-9 value after surgery, poor differentiation grade, and positive lymph nodes were found to be independently associated with recurrence. The patients receiving adjuvant chemotherapy had a decreased likelihood of recurrence. In the high CA19-9 value cohort, the median PFS and OS of the patients with or without chemotherapy were 8.0 VS. 5.7 months and 15.6 VS. 13.8 months, respectively. In the normal CA19-9 value cohort, there was no significant difference in PFS with or without chemotherapy (11.7 VS. 10.0 months, P = 0.147). However, OS was significantly longer in the patients with chemotherapy (26.4 VS. 13.8 months, P = 0.019).
Tumor biologic characteristics, such as T stage, tumor differentiation and positive lymph nodes, affecting CA19-9 value after surgery are associated with patterns and timing of recurrence. Adjuvant chemotherapy significantly reduced recurrence and improved survival. Chemotherapy is strongly recommended in patients with high CA199 after surgery.
切除术后的复发是影响生存的主要因素。然而，对于接受根治性胰体尾切除术的胰腺导管腺癌（PDAC）患者，术后复发与临床病理因素之间的关系尚未得到充分研究。
回顾性分析 2015 年 5 月至 2021 年 8 月期间接受左侧胰体尾切除术的 PDAC 患者。
共纳入 141 例患者。97 例（68.8%）患者发生复发，44 例（31.2%）患者无复发。中位无复发生存期（RFS）为 8.8 个月，中位总生存期（OS）为 24.9 个月。局部复发是最常见的首次检测到的复发部位（n=36，37.1%），其次是肝转移（n=35，36.1%）。16 例（16.5%）患者出现多处复发，6 例（6.2%）患者出现腹膜转移，4 例（4.1%）患者出现肺转移。术后 CA19-9 水平升高、分化程度差和淋巴结阳性被发现与复发独立相关。接受辅助化疗的患者复发的可能性降低。在 CA19-9 水平升高的患者中，化疗组和非化疗组的中位无进展生存期（PFS）和 OS 分别为 8.0 个月和 5.7 个月，15.6 个月和 13.8 个月。在 CA19-9 水平正常的患者中，化疗组和非化疗组的 PFS 差异无统计学意义（11.7 个月比 10.0 个月，P=0.147）。然而，化疗组的 OS 显著延长（26.4 个月比 13.8 个月，P=0.019）。
影响术后 CA19-9 值的肿瘤生物学特征，如 T 分期、肿瘤分化程度和淋巴结阳性，与复发模式和时间有关。辅助化疗可显著降低复发率，提高生存率。对于术后 CA199 升高的患者强烈推荐化疗。
