Kaluba Benson, Kuriyama Naohisa, Nagata Motonori, Ito Takahiro, Hayasaki Aoi, Fujii Takehiro, Murata Yasuhiro, Tanemura Akihiro, Kishiwada Masashi, Mizuno Shugo
Department of Hepatobiliary Pancreatic and Transplant Surgery Mie University Graduate School of Medicine Tsu Japan.
Department of Radiology Mie University School of Medicine Tsu Japan.
Ann Gastroenterol Surg. 2025 Apr 10;9(4):842-860. doi: 10.1002/ags3.70002. eCollection 2025 Jul.
To assess the ability of a new severity-based tumor-superior mesenteric/portal vein interface criteria to predict survival outcomes in pancreatic ductal adenocarcinoma patients undergoing pancreaticoduodenectomy after neoadjuvant chemoradiotherapy (CRT).
Two hundred and twenty-six post-CRT patients were enrolled and 22 had no tumor-SMV/PV contact, while the remaining 204 had. Based on correlation with overall survival (OS), circumferential (210 degrees) and contact length (25 mm) interface cut-off values were identified, then used to formulate no tumor-SMV/PV contact, non-severe, and severe interface criteria. Significant predictors of disease-free (DFS) and OS were identified.
The severe group had significantly more UR-LA, cStage 3 cases, longer operation times, more intra-operative blood loss, R1 resection, and pPV invasion cases than the no tumor-contact and non-severe interface groups ( < 0.001). Median DFS were 37.7 (no tumor-contact), 17.0 (non-severe), and 5.2 (severe) months and OS was 56.7, 29.9, and 12.0. Among tumor-contact patients, the interface criteria (84.7%) had a better specificity in predicting pPV invasion than tumor-contact length (76.9%) and tumor-circumferential interface (73.8%). Those with pPV invasion had shorter DFS (16.7 vs. 5.7) and OS (28.3 vs. 13.6) than those without pPV invasion. Significant independent predictors of both DFS and OS were the interface criteria, resection margins, and pPV invasion. Clinical and pathological lymph node involvement also influenced DFS, while circumferential interface and pathological tumor stage also impacted OS.
Patients can be stratified as no tumor-contact, non-severe, or severe interface cases and the criteria might be useful in preoperatively predicting not only survival but also intra-operative outcomes and pPV invasion.
评估一种基于新的严重程度的肿瘤-肠系膜上静脉/门静脉界面标准预测新辅助放化疗（CRT）后接受胰十二指肠切除术的胰腺导管腺癌患者生存结局的能力。
纳入226例CRT后的患者，其中22例无肿瘤与肠系膜上静脉/门静脉接触，其余204例有接触。基于与总生存期（OS）的相关性，确定了圆周（210度）和接触长度（25毫米）界面截断值，然后用于制定无肿瘤-肠系膜上静脉/门静脉接触、非严重和严重界面标准。确定了无病生存期（DFS）和OS的显著预测因素。
与无肿瘤接触组和非严重界面组相比，严重组的UR-LA、cStage 3病例显著更多，手术时间更长，术中失血量更多，R1切除和pPV侵犯病例更多（<0.001）。中位DFS分别为37.7个月（无肿瘤接触）、17.0个月（非严重）和5.2个月（严重），OS分别为56.7个月、29.9个月和12.0个月。在有肿瘤接触的患者中，界面标准（84.7%）在预测pPV侵犯方面比肿瘤接触长度（76.9%）和肿瘤圆周界面（73.8%）具有更好的特异性。有pPV侵犯的患者的DFS（16.7对5.7）和OS（28.3对13.6）比无pPV侵犯的患者短。DFS和OS的显著独立预测因素是界面标准、切缘和pPV侵犯。临床和病理淋巴结受累也影响DFS，而圆周界面和病理肿瘤分期也影响OS。
患者可分为无肿瘤接触、非严重或严重界面病例，该标准不仅可用于术前预测生存，还可预测术中结局和pPV侵犯。
