Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
PLoS One. 2024 Sep 6;19(9):e0309834. doi: 10.1371/journal.pone.0309834. eCollection 2024.
Prognostic implications of peritoneal washing cytology (CY) in patients with localized pancreatic ductal adenocarcinoma (PDAC) undergoing surgical resection following preoperative chemoradiotherapy (CRT) remain unclear. This study aimed to elucidate the prognostic significance and predictors of a positive CY status (CY+) after preoperative CRT.
Clinical data from 141 patients with localized PDAC who underwent curative-intent resection after preoperative CRT were retrospectively analyzed to examine the association between CY+ and clinicopathological factors and survival.
CY+ was observed in six patients (4.3%). The CY+ group exhibited significantly higher preoperative serum levels of CA19-9 and a substantially greater incidence of tumor location in the pancreatic body or tail, along with pathological invasion to the anterior pancreatic capsule, than the CY- group. The CY+ group had a significantly higher incidence of peritoneal recurrence compared with the CY- group (83.3% vs. 18.5%, p = 0.002). Overall survival (OS) and recurrence-free survival (RFS) after surgery were significantly shorter in the CY+ group than in the CY- group (CY+ vs. CY-: 18.3 vs. 46.2 months, p = 0.001, and 8.9 vs. 17.7 months, p = 0.009, respectively). Multivariate analyses identified CY+ as an independent prognostic factor for worse OS (hazard ratio 5.00, 95% confidence interval 1.03-12.31) and RFS (hazard ratio 2.58, 95% confidence interval 1.04-6.43). Local invasion grade on imaging before CRT, limited histological response to CRT, and absence of adjuvant chemotherapy were independent predictors of worse OS and RFS.
Despite the relatively low incidence of CY+ after preoperative CRT, it emerged as an independent prognostic factor in patients with localized PDAC undergoing curative-intent resection following preoperative CRT.
接受术前放化疗（CRT）后行手术切除的局限性胰腺导管腺癌（PDAC）患者中，腹膜冲洗细胞学（CY）的预后意义仍不清楚。本研究旨在阐明术前 CRT 后 CY 阳性（CY+）的预后意义和预测因素。
回顾性分析了 141 例接受术前 CRT 后行根治性切除术的局限性 PDAC 患者的临床资料，以研究 CY+与临床病理因素和生存的关系。
6 例（4.3%）患者出现 CY+。CY+组术前血清 CA19-9 水平显著升高，肿瘤位于胰体或胰尾，且前胰腺包膜侵犯的发生率明显较高，而 CY-组则较低。与 CY-组相比，CY+组的腹膜复发率显著较高（83.3% vs. 18.5%，p=0.002）。与 CY-组相比，CY+组的术后总生存（OS）和无复发生存（RFS）显著更短（CY+ vs. CY-：18.3 与 46.2 个月，p=0.001，8.9 与 17.7 个月，p=0.009）。多因素分析表明，CY+是 OS（危险比 5.00，95%置信区间 1.03-12.31）和 RFS（危险比 2.58，95%置信区间 1.04-6.43）较差的独立预后因素。术前 CRT 前影像学上的局部侵犯程度、对 CRT 的有限组织学反应和缺乏辅助化疗是 OS 和 RFS 较差的独立预测因素。
尽管术前 CRT 后 CY+的发生率相对较低，但它仍是接受术前 CRT 后行根治性切除术的局限性 PDAC 患者的独立预后因素。
