导管内乳头状黏液性肿瘤衍生胰腺癌的最佳治疗策略：早期复发的定义与预测——一项国际多中心研究
Defining and Predicting Early Recurrence for Optimal Treatment Strategies for Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: An International Multicenter Study.
作者信息
Habib Joseph R, Javed Ammar A, Rompen Ingmar F, Hidalgo Salinas Camila, Sorrentino Anthony, Campbell Brady A, Andel Paul C M, Groot Vincent P, Lafaro Kelly J, Sacks Greg D, Billeter Adrian T, Molenaar I Quintus, Müller-Stich Beat P, Besselink Marc G, He Jin, Wolfgang Christopher L, Daamen Lois A
机构信息
Department of Surgery, New York University Langone Health, New York, NY, USA.
Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
出版信息
Ann Surg Oncol. 2025 Mar;32(3):1879-1886. doi: 10.1245/s10434-024-16649-z. Epub 2024 Dec 12.
BACKGROUND
Early recurrence in intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) is poorly defined. Predictors are lacking and needed for patient counseling, risk stratification, and postoperative management. This study aimed to define and predict early recurrence for patients in resected IPMN-derived PDAC and guide management.
METHODS
A lowest p value for survival after recurrence (SAR) was used to define early recurrence in resected IPMN-derived PDAC from five international centers. Overall survival (OS) and SAR were compared using log-rank tests. A multivariable logistic regression identified odds ratios (ORs) with 95 % confidence intervals (CIs) for early recurrence. Rounded ORs were used to stratify patients into low-, intermediate-, and high-risk groups using upper and lower quartile score distributions. Adjuvant chemotherapy was assessed by Cox regression and log-rank tests for OS in risk groups.
RESULTS
Recurrence developed in 160 (42 %) of 381 patients. Early recurrence was defined at 10.5 months and observed in 61 patients (38 % of recurrences). The median SAR for the patients with early recurrence was 8.3 months (95 % CI, 3.1-16.1 months) compared with 12.9 months (95 % CI, 5.2-27.5 months) for the patients with late recurrence. The independent predictors of early recurrence were CA19-9 (OR, 3.80; 95 % CI, 1.54-9.41) and N2 disease (OR, 7.29; 95 % CI, 3.22-16.49). The early recurrence rates in the low-, intermediate-, and high-risk groups were respectively 1 %, 14 %, and 32 %. Adjuvant chemotherapy was associated with improved OS only for the high-risk patients (hazard ratio, 0.50; 95 % CI, 0.32-0.79).
CONCLUSION
In IPMN-derived PDAC, the optimal cutoff for early recurrence is 10.5 months. Both CA19-9 and N stage predict early recurrence. Adjuvant chemotherapy is associated with survival benefit only for high-risk patients.
背景
导管内乳头状黏液性肿瘤（IPMN）衍生的胰腺导管腺癌（PDAC）的早期复发定义尚不明确。缺乏预测指标，而这些指标对于患者咨询、风险分层和术后管理是必要的。本研究旨在明确并预测接受手术切除的IPMN衍生的PDAC患者的早期复发情况，并指导治疗管理。
方法
采用复发后生存（SAR）的最低p值来定义来自五个国际中心的接受手术切除的IPMN衍生的PDAC的早期复发。使用对数秩检验比较总生存期（OS）和SAR。多变量逻辑回归确定早期复发的比值比（OR）及其95%置信区间（CI）。使用上下四分位数得分分布，将四舍五入后的OR用于将患者分为低、中、高风险组。通过Cox回归和对数秩检验评估风险组中辅助化疗对OS的影响。
结果
381例患者中有160例（42%）出现复发。早期复发定义为10.5个月，61例患者（占复发患者的38%）出现早期复发。早期复发患者的SAR中位数为8.3个月（95%CI，3.1 - 16.1个月），而晚期复发患者为12.9个月（95%CI，5.2 - 27.5个月）。早期复发的独立预测因素为CA19 - 9（OR，3.80；95%CI，1.54 - 9.41）和N2期疾病（OR，7.29；95%CI，3.22 - 16.49）。低、中、高风险组的早期复发率分别为1%、14%和32%。辅助化疗仅对高风险患者的OS有改善作用（风险比，0.50；95%CI，0.32 - 0.79）。
结论
在IPMN衍生的PDAC中，早期复发的最佳截断值为10.5个月。CA19 - 9和N分期均能预测早期复发。辅助化疗仅对高风险患者有生存获益。
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