切除的胰腺导管腺癌长期存活者的不良预后因素：一项国际多中心队列研究

Poor Prognostic Factors in Long-Term Survivors of Resected Pancreatic Ductal Adenocarcinoma: An International, Multicenter Cohort Study.

作者信息

Javed Ammar A, Rompen Ingmar F, van Goor Iris W J M, Stoop Thomas F, Andel Paul, Mahmud Omar, Fatimi Asad Saulat, Habib Joseph R, Mughal Nabiha A, Schouten Thijs, Lafaro Kelly, Burkhart Richard A, Burns William R, Santvoort Hjalmar C van, Dulk Marcel den, Daams Freek, Mieog J Sven D, Stommel Martijn W J, Patijn Gijs A, Hingh Ignace de, Festen Sebastiaan, Nijkamp Maarten W, Klaase Joost M, Lips Daan J, Wijsman Jan H, Harst Erwin van der, Manusama Eric, Eijck Casper H J van, Koerkamp Bas Groot, Kazemier Geert, Busch Olivier R, Molenaar I Quintus, Daamen Lois A, He Jin, Wolfgang Christopher L, Besselink Marc G

机构信息

Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA.

Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.

出版信息

Ann Surg. 2024 Sep 17. doi: 10.1097/SLA.0000000000006539.

DOI:10.1097/SLA.0000000000006539

PMID:39286904

Abstract

OBJECTIVE

To measure the rate of LTS in resected PDAC and determine the association between predictors of OS and LTS.

SUMMARY BACKGROUND DATA

Long-term survival (>5 y, LTS) remains rare in pancreatic ductal adenocarcinoma (PDAC). Multiple predictors of overall survival (OS) are known but their association with LTS remains unclear.

METHODS

An international, multicenter retrospective study was conducted. Included were patients from 2012-2019 with resected PDAC. Excluded were those with metastases at diagnosis or resection, R2 resections, and 90-day mortality. Predictors of OS were identified using multivariable Cox regression and their prevalence in patients with LTS assessed. LTS was calculated by excluding patients with shorter follow-up and predictors of LTS were identified using multivariable logistic regression.

RESULTS

3,003 patients were included (27.4% received neoadjuvant chemotherapy). Elevated baseline CA19-9, high tumor grade, nodal disease, and perineural and lymphovascular invasion were negative independent predictors of OS, while receipt of adjuvant chemotherapy predicted improved OS (all P<0.05). LTS was observed in 220/2,436 patients (9.0%), of whom 198 (90%) harbored poor prognostic factors: elevated baseline CA19-9 (58.1%), poor tumor differentiation (51.0%), nodal disease (46.8%), and perineural invasion (76.0%). Of those without any of these four features, 50.0% achieved LTS as compared to 21.3%, 13.3%, 5.2%, and 3.5% in those with 1, 2, 3, or 4 features.

CONCLUSIONS

This bi-national cohort demonstrates a true LTS rate of 9.0% in resected PDAC. Clinicians should remain aware that presence of poor prognostic factors does not preclude LTS.

摘要

目的

测量接受手术切除的胰腺导管腺癌（PDAC）患者的长期生存率（LTS），并确定总生存期（OS）预测因素与LTS之间的关联。

总结背景数据

胰腺导管腺癌（PDAC）患者的长期生存（>5年，LTS）仍然罕见。已知多个总生存期（OS）预测因素，但其与LTS的关联仍不清楚。

方法

开展一项国际多中心回顾性研究。纳入2012年至2019年接受手术切除的PDAC患者。排除诊断或切除时伴有转移、R2切除以及90天内死亡的患者。使用多变量Cox回归确定OS预测因素，并评估其在LTS患者中的患病率。通过排除随访时间较短的患者来计算LTS，并使用多变量逻辑回归确定LTS预测因素。

结果

共纳入3003例患者（27.4%接受新辅助化疗）。基线CA-19-9升高、肿瘤分级高、淋巴结转移以及神经周围和淋巴管侵犯是OS的独立阴性预测因素，而接受辅助化疗可改善OS（均P<0.05）。2436例患者中有220例（9.0%）观察到LTS，其中198例（90%）具有不良预后因素：基线CA-19-9升高（58.1%）、肿瘤分化差（51.0%）、淋巴结转移（46.8%）和神经周围侵犯（76.0%）。在无这四种特征中任何一种的患者中，50.0%实现了LTS，而在具有1、2、3或4种特征的患者中这一比例分别为21.3%、13.3%、5.2%和3.5%。