Cedars-Sinai Medical Center, Los Angeles, California, USA.
Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Clin Transl Gastroenterol. 2024 Jul 1;15(7):e00719. doi: 10.14309/ctg.0000000000000719.
Pancreatic ductal adenocarcinoma is associated with significant morbidity and mortality as most patients present with advanced disease. The development of ascites has been associated with poor outcomes and further characterization and contemporary management strategies are needed.
A total of 437 patients enrolled in the Gastrointestinal Biobank at Cedars-Sinai Medical Center who had epithelial pancreatic malignancy were included in the prospective cohort group. Overall, 41.7% of patients included in this study developed ascites. Most patients with ascites (>80%) had high serum-ascites albumin gradient ascites. In both univariate and multivariate analysis, a history of ≥1 form of chemotherapy was significantly associated with ascites. Estimated median overall survival in patients with ascites was significantly lower than in patients without ascites, 473 days vs 573 days, and ascites had a hazard ratio of 1.37.
Patients with ascites who received diuretics and indwelling peritoneal catheter had an estimated median survival of 133 days from diagnosis of ascites, and those who received only the indwelling peritoneal catheter without diuretics had an estimated median survival of only 54 days. The estimated median survival from the diagnosis of ascites was 92 days, and the median time to puncture was 7 days. The median time from first tap to death was 45 days.
The use of diuretics is lower than would be expected for patients with pancreatic ductal adenocarcinoma with elevated serum-ascites albumin gradient. Other therapies such as beta blockers should be investigated in this subset of patients. The etiology of ascites in these patients is poorly understood, and further research is needed to establish treatment guidelines and improve outcomes.
大多数患有胰腺导管腺癌的患者在就诊时已处于晚期，因此其发病率和死亡率都很高。腹水的出现与不良预后相关，需要进一步明确其特征并制定现代管理策略。
共有 437 名在 Cedars-Sinai 医疗中心胃肠道生物库登记的患有上皮性胰腺恶性肿瘤的患者被纳入前瞻性队列组。本研究中，共有 41.7%的患者出现腹水。大多数有腹水的患者（>80%）存在高血清-腹水白蛋白梯度腹水。单因素和多因素分析均显示，有≥1种化疗史与腹水显著相关。有腹水患者的估计中位总生存期明显低于无腹水患者，分别为 473 天和 573 天，腹水的风险比为 1.37。
接受利尿剂和留置腹腔导管的腹水患者从诊断腹水开始的估计中位生存期为 133 天，而仅接受留置腹腔导管而未接受利尿剂的患者的估计中位生存期仅为 54 天。从腹水诊断开始的估计中位生存期为 92 天，穿刺时间的中位数为 7 天。首次穿刺至死亡的中位时间为 45 天。
利尿剂的使用低于预期，对于血清-腹水白蛋白梯度升高的胰腺导管腺癌患者。应该在这部分患者中研究其他治疗方法，如β受体阻滞剂。这些患者腹水的病因尚不清楚，需要进一步研究以制定治疗指南并改善预后。
