Bellotti Ruben, Paiella Salvatore, Primavesi Florian, Jäger Carsten, Demir Ihsan E, Casciani Fabio, Kornprat Peter, Wagner Doris, Rösch Christiane S, Butturini Giovanni, Giardino Alessandro, Goretzky Peter E, Mogl Martina, Fahlbusch Tim, Kaiser Jörg, Strobel Oliver, Nießen Anna, Luu Andreas M, Salvia Roberto, Maglione Manuel
Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria.
General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy.
HPB (Oxford). 2023 Nov;25(11):1411-1419. doi: 10.1016/j.hpb.2023.07.897. Epub 2023 Jul 27.
Acinar cell carcinomas (ACC) belong to the exocrine pancreatic malignancies. Due to their rarity, there is no consensus regarding treatment strategies for resectable ACC.
This is a retrospective multicentric study of radically resected pure pancreatic ACC. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Further endpoints were oncologic outcomes related to tumor stage and therapeutic protocols.
59 patients (44 men) with a median age of 64 years were included. The median tumor size was 45.0 mm. 61.0% were pT3 (n = 36), nodal positivity rate was 37.3% (n = 22), and synchronous distant metastases were present in 10.1% of the patients (n = 6). 5-Years OS was 60.9% and median DFS 30 months. 24 out of 31 recurred systemically (n = 18 only systemic, n = 6 local and systemic). Regarding TNM-staging, only the N2-stage negatively influenced OS and DFS (p = 0.004, p = 0.001). Adjuvant treatment protocols (performed in 62.7%) did neither improve OS (p = 0.542) nor DFS (p = 0.159). In 9 cases, radical resection was achieved following neoadjuvant therapy.
Radical surgery is currently the mainstay for resectable ACC, even for limited metastatic disease. Novel (neo)adjuvant treatment strategies are needed, since current systemic therapies do not result in a clear survival benefit in the perioperative setting.
腺泡细胞癌（ACC）属于胰腺外分泌恶性肿瘤。由于其罕见性，对于可切除ACC的治疗策略尚无共识。
这是一项对根治性切除的纯胰腺ACC进行的回顾性多中心研究。主要终点是总生存期（OS）和无病生存期（DFS）。其他终点是与肿瘤分期和治疗方案相关的肿瘤学结果。
纳入59例患者（44例男性），中位年龄64岁。中位肿瘤大小为45.0毫米。61.0%为pT3（n = 36），淋巴结阳性率为37.3%（n = 22），10.1%的患者（n = 6）存在同步远处转移。5年总生存率为60.9%，中位无病生存期为30个月。31例复发患者中有24例发生全身转移（n = 18例仅为全身转移，n = 6例为局部和全身转移）。关于TNM分期，只有N2期对总生存期和无病生存期有负面影响（p = 0.004，p = 0.001）。辅助治疗方案（62.7%的患者接受）既未改善总生存期（p = 0.542）也未改善无病生存期（p = 0.159）。9例患者在新辅助治疗后实现了根治性切除。
根治性手术目前是可切除ACC的主要治疗方法，即使对于有限的转移性疾病也是如此。由于目前的全身治疗在围手术期环境中未带来明显的生存获益，因此需要新的（新）辅助治疗策略。
