同时性和异时性转移性胰腺腺癌患者的疾病传播模式和生存率：基于全国人群的研究。
Patterns of disease dissemination and survival in patients with synchronous and metachronous metastatic pancreatic adenocarcinoma: Nationwide population-based study.
作者信息
Graus Merlijn U J E, van Diepen Aniek E, Josemanders Kim, Besselink Marc G, Bouwense Stefan A W, Daamen Lois A, de Hingh Ignace H J T, de Jong Evelien J M, van Laarhoven Hanneke W M, de Meijer Vincent E, Quintus Molenaar I, Stommel Martijn W J, Valkenburg-van Iersel Liselot B J, Wilmink Johanna W, van der Geest Lydia G M, de Vos-Geelen Judith
机构信息
Maastricht University Medical Center, Department of Internal Medicine, Division of Medical Oncology, Maastricht, the Netherlands; GROW - Research institute for Oncology & Reproduction, Maastricht University, Maastricht, the Netherlands.
Canisius Wilhelmina Hospital (CWZ), Department oF Internal Medicine, Nijmegen, the Netherlands.
出版信息
Eur J Cancer. 2025 May 2;220:115385. doi: 10.1016/j.ejca.2025.115385. Epub 2025 Mar 23.
AIM
Despite advances in understanding pancreatic adenocarcinoma, evidence on its metastatic patterns and impact on patient survival remains limited. This study aims to identify patterns of disease dissemination in synchronous versus metachronous metastatic pancreatic adenocarcinoma (mPAC) and their association with overall survival (OS).
METHODS
Patients diagnosed with synchronous- or metachronous-mPAC were selected from the Netherlands Cancer Registry (2015-2021). Patient, tumor, and treatment characteristics were compared using Chi-squared tests. Survival data, calculated from detection of metastatic disease (OS-M), were analyzed using Kaplan-Meier and Log-rank tests.
RESULTS
Overall, 10,788 patients with synchronous- and 508 with metachronous-mPAC were included. Median time to first metastasis in metachronous-mPAC was 13.2 months (IQR 9-23), varying significantly by metastatic site (liver-only 11.5; lung-only 28.0 months). Compared to synchronous-mPAC, patients with metachronous-mPAC had less liver metastases (48 % versus 75 %, p < 0.001), but more lung (29 % versus 21 %, p < 0.001) and peritoneal (35 % versus 25 %, p < 0.001) metastases. Synchronous metastases to liver-only, lung-only, lymph node-only, or multiple sites at first diagnosis had a median OS-M that was (nearly) half compared to metachronous metastases to the same sites. Bone-only or peritoneum-only metastases in synchronous-mPAC showed a median OS-M comparable to metachronous-mPAC.
CONCLUSION
This nationwide population-based study reveals that metachronous-mPAC less commonly presents with liver metastases and more often metastasizes to lung, peritoneum or other atypical sites compared to synchronous-mPAC. These distinct metastatic patterns and their differences in survival may help enhance the prognostic estimation for individual patients from the detection of metastatic disease and warrants further research into the biology underlying metastasis development.
目的
尽管在胰腺癌的认识方面取得了进展，但其转移模式及对患者生存影响的证据仍然有限。本研究旨在确定同时性与异时性转移性胰腺癌（mPAC）的疾病播散模式及其与总生存期（OS）的关联。
方法
从荷兰癌症登记处（2015 - 2021年）选取诊断为同时性或异时性mPAC的患者。使用卡方检验比较患者、肿瘤和治疗特征。从转移性疾病检测开始计算的生存数据（OS - M），采用Kaplan - Meier法和对数秩检验进行分析。
结果
总体而言，纳入了10788例同时性mPAC患者和508例异时性mPAC患者。异时性mPAC首次转移的中位时间为13.2个月（四分位间距9 - 23），因转移部位不同而有显著差异（仅肝转移11.5个月；仅肺转移28.0个月）。与同时性mPAC相比，异时性mPAC患者肝转移较少（48%对75%，p < 0.001），但肺转移（29%对21%，p < 0.001）和腹膜转移（35%对25%，p < 0.001）较多。首次诊断时仅肝、仅肺、仅淋巴结或多个部位的同时性转移，其OS - M中位数与相同部位的异时性转移相比（几乎）减半。同时性mPAC中仅骨或仅腹膜转移的OS - M中位数与异时性mPAC相当。
结论
这项基于全国人群的研究表明，与同时性mPAC相比，异时性mPAC较少出现肝转移，更常转移至肺、腹膜或其他非典型部位。这些不同的转移模式及其生存差异可能有助于从转移性疾病检测时提高对个体患者的预后估计，并且有必要进一步研究转移发生的生物学基础。
Zotero 插件