胰尾可切除胰腺导管腺癌胰外器官侵犯的预后意义

Prognostic implication of extra-pancreatic organ invasion in resectable pancreas ductal adenocarcinoma in the pancreas tail.

作者信息

Ji Jang Hyeon, Soo Lee Seung, Baek Seunghee, Jeong Boryeong, Wook Kim Dong, Hee Kim Jin, Jung Kim Hyoung, Ho Byun Jae, Lee Woohyung, Cheol Kim Song

机构信息

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

出版信息

Eur J Radiol. 2024 Dec;181:111715. doi: 10.1016/j.ejrad.2024.111715. Epub 2024 Sep 2.

DOI:10.1016/j.ejrad.2024.111715

PMID:39241306

Abstract

OBJECTIVES

To assess the prognostic significance of extra-pancreatic organ invasion in patients with resectable pancreatic ductal adenocarcinoma (PDAC) in the pancreas tail.

MATERIALS & METHODS: This retrospective study included patients with resectable PDAC in the pancreas tail who received upfront surgery between 2014 and 2020 at a tertiary institution. Preoperative pancreas protocol computed tomography (CT) scans evaluated tumor size, peripancreatic tumor infiltration, suspicious metastatic lymph nodes, and extra-pancreatic organ invasion. The influence of extra-pancreatic organ invasion, detected by CT or postoperative pathology, on pathologic resection margin status was evaluated using logistic regression. The impact on recurrence-free survival (RFS) was analyzed using multivariable Cox proportional hazard models (clinical-CT and clinical-pathologic).

RESULTS

The study included 158 patients (mean age, 65 years ± 8.8 standard deviation; 93 men). Extra-pancreatic organ invasion identified by either CT (p = 0.92) or pathology (p = 0.99) was not associated with a positive resection margin. Neither CT (p = 0.42) nor pathological (p = 0.64) extra-pancreatic organ invasion independently correlated with RFS. Independent predictors for RFS included suspicious metastatic lymph node (hazard ratio [HR], 2.05; 95 % confidence interval [CI], 1.08-3.9; p = 0.03) on CT in the clinical-CT model, pathological T stage (HR, 2.97; 95 % confidence interval [CI], 1.39-6.35; p = 0.005 for T2 and HR, 3.78; 95 % CI, 1.64-8.76; p = 0.002 for T3) and adjuvant therapy (HR, 0.62; 95 % confidence interval [CI], 0.42-0.92; p = 0.02) in the clinical-pathologic model.

CONCLUSION

Extra-pancreatic organ invasion does not independently influence pathologic resection margin status and RFS in patients with resectable PDAC in the pancreas tail after curative-intent resection; therefore, it should not be considered a high-risk factor.

摘要

目的

评估胰尾可切除性胰腺导管腺癌（PDAC）患者胰外器官侵犯的预后意义。

材料与方法

这项回顾性研究纳入了2014年至2020年在一家三级医疗机构接受 upfront 手术的胰尾可切除性PDAC患者。术前胰腺协议计算机断层扫描（CT）评估肿瘤大小、胰腺周围肿瘤浸润、可疑转移性淋巴结和胰外器官侵犯。使用逻辑回归评估CT或术后病理检测到的胰外器官侵犯对病理切缘状态的影响。使用多变量Cox比例风险模型（临床CT和临床病理）分析对无复发生存期（RFS）的影响。

结果

该研究纳入了158例患者（平均年龄65岁±8.8标准差；93例男性）。CT（p = 0.92）或病理（p = 0.99）确定的胰外器官侵犯与切缘阳性无关。CT（p = 0.42）和病理（p = 0.64）的胰外器官侵犯均与RFS无独立相关性。RFS的独立预测因素在临床CT模型中包括CT上可疑转移性淋巴结（风险比[HR]，2.05；95%置信区间[CI]，1.08 - 3.9；p = 0.03），在临床病理模型中包括病理T分期（HR，2.97；95%置信区间[CI]，1.39 - 6.35；T2时p = 0.005，HR，3.78；95% CI，1.64 - 8.76；T3时p = 0.002）和辅助治疗（HR，0.62；95%置信区间[CI]，0.42 - 0.92；p = 0.02）。