导管内乳头状黏液性肿瘤（IPMN）相关腺癌手术切除后的复发风险、分布模式及治疗：一项国际多中心观察性研究（ADENO - IPMN研究）
Risk of Recurrence After Surgical Resection for Adenocarcinoma Arising From Intraductal Papillary Mucinous Neoplasia (IPMN) With Patterns of Distribution and Treatment: An International, Multicenter, Observational Study (ADENO-IPMN Study).
作者信息
Lucocq James, Hawkyard Jake, Robertson Francis P, Haugk Beate, Lye Jonathan, Parkinson Daniel, White Steve, Mownah Omar, Zen Yoh, Menon Krishna, Furukawa Takaaki, Inoue Yosuke, Hirose Yuki, Sasahira Naoki, Feretis Michael, Balakrishnan Anita, Zelga Piotr, Ceresa Carlo, Davidson Brian, Pande Rupaly, Dasari Bobby, Tanno Lulu, Karavias Dimitrios, Helliwell Jack, Young Alistair, Nunes Quentin, Urbonas Tomas, Silva Michael, Gordon-Weeks Alex, Barrie Jenifer, Gomez Dhanny, van Laarhoven Stijn, Doyle Joseph, Bhogal Ricky, Harrison Ewen, Roalso Marcus, Ciprani Debora, Aroori Somaiah, Ratnayake Bathiya, Koea Jonathan, Capurso Gabriele, Bellotti Ruben, Stättner Stefan, Alsaoudi Tareq, Bhardwaj Neil, Jeffery Fraser, Connor Saxon, Cameron Andrew, Jamieson Nigel, Sheen Amy, Mittal Anubhav, Samra Jas, Gill Anthony, Roberts Keith, Soreide Kjetil, Pandanaboyana Sanjay
机构信息
Department of General Surgery, NHS Lothian, UK.
Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK.
出版信息
Ann Surg. 2024 Jul 1;280(1):126-135. doi: 10.1097/SLA.0000000000006144. Epub 2023 Oct 24.
OBJECTIVE
This international multicenter cohort study aims to identify recurrence patterns and treatment of first and second recurrence in a large cohort of patients after pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasm (IPMN).
BACKGROUND
Recurrence patterns and treatment of recurrence postresection of adenocarcinoma arising from IPMN are poorly explored.
METHODS
Patients undergoing pancreatic resection for adenocarcinoma from IPMN between January 2010 and December 2020 at 18 pancreatic centers were identified. Survival analysis was performed using the Kaplan-Meier log-rank test and multivariable logistic regression by Cox-Proportional Hazards modeling. End points were recurrence (time-to, location, and pattern of recurrence) and survival (overall survival and adjusted for treatment provided).
RESULTS
Four hundred fifty-nine patients were included (median, 70 years; interquartile range, 64-76; male, 54%) with a median follow-up of 78.1 months. Recurrence occurred in 209 patients [45.5%; median time to recurrence, 12.8 months; early recurrence (within 1 years), 23.2%]. Eighty-three (18.1%) patients experienced a local regional recurrence, and 164 (35.7%) patients experienced a distant recurrence. Adjuvant chemotherapy was not associated with reduction in recurrence (hazard ratio 1.09; P =0.669) One hundred twenty patients with recurrence received further treatment. The median survival with and without additional treatment was 27.0 and 14.6 months ( P <0.001), with no significant difference between treatment modalities. There was no significant difference in survival between locations of recurrence ( P =0.401).
CONCLUSIONS
Recurrence after pancreatic resection for adenocarcinoma arising from IPMN is frequent with a quarter of patients recurring within 12 months. Treatment of recurrence is associated with improved overall survival and should be considered.
目的
这项国际多中心队列研究旨在确定一大群导管内乳头状黏液性肿瘤（IPMN）来源的腺癌患者在胰腺切除术后首次和第二次复发的模式及治疗方法。
背景
IPMN来源的腺癌切除术后的复发模式及复发治疗尚未得到充分研究。
方法
确定了2010年1月至2020年12月期间在18个胰腺中心因IPMN来源的腺癌接受胰腺切除术的患者。使用Kaplan-Meier对数秩检验和Cox比例风险模型进行多变量逻辑回归分析进行生存分析。终点指标为复发（复发时间、部位和模式）和生存（总生存期以及根据所提供的治疗进行调整）。
结果
纳入459例患者（中位年龄70岁；四分位间距64 - 76岁；男性占54%），中位随访时间为78.1个月。209例患者出现复发[45.5%；复发的中位时间为12.8个月；早期复发（1年内）占23.2%]。83例（18.1%）患者发生局部区域复发，164例（35.7%）患者发生远处复发。辅助化疗与复发减少无关（风险比1.09；P = 0.669）。120例复发患者接受了进一步治疗。接受和未接受额外治疗的患者中位生存期分别为27.0个月和14.6个月（P < 0.001），治疗方式之间无显著差异。复发部位之间的生存率无显著差异（P = 0.401）。
结论
IPMN来源的腺癌胰腺切除术后复发很常见，四分之一的患者在12个月内复发。复发的治疗与总体生存率的改善相关，应予以考虑。
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