Preoperative evaluation of pancreatic ductal adenocarcinoma with synchronous liver metastasis: Diagnosis and assessment of unresectability.
Preoperative evaluation of pancreatic ductal adenocarcinoma with synchronous liver metastasis: Diagnosis and assessment of unresectability.
复制标题
胰腺导管腺癌同时性肝转移的术前评估：诊断和不可切除性评估
DOI：
10.3748/wjg.v22.i45.10024
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发表时间：
2016-12-07
影响因子：
4.3
通讯作者：
Fu DL
中科院分区：
文献类型：
--
作者：
Shi HJ;Jin C;Fu DL
To identify predictors for synchronous liver metastasis from resectable pancreatic ductal adenocarcinoma (PDAC) and assess unresectability of synchronous liver metastasis. Retrospective records of PDAC patients with synchronous liver metastasis who underwent simultaneous resections of primary PDAC and synchronous liver metastasis, or palliative surgical bypass, were collected from 2007 to 2015. A series of pre-operative clinical parameters, including tumor markers and inflammation-based indices, were analyzed by logistic regression to figure out predictive factors and assess unresectability of synchronous liver metastasis. Cox regression was used to identify prognostic factors in liver-metastasized PDAC patients after surgery, with intention to validate their conformance to the indications of simultaneous resections and palliative surgical bypass. Survival of patients from different groups were analyzed by the Kaplan-Meier method. Intra- and post-operative courses were compared, including complications. PDAC patients with no distant metastases who underwent curative resection served as the control group. CA125 > 38 U/mL (OR = 12.397, 95%CI: 5.468-28.105, P < 0.001) and diabetes mellitus (OR = 3.343, 95%CI: 1.539-7.262, P = 0.002) independently predicted synchronous liver metastasis from resectable PDAC. CA125 > 62 U/mL (OR = 5.181, 95%CI: 1.612-16.665, P = 0.006) and age > 62 years (OR = 3.921, 95%CI: 1.217-12.632, P = 0.022) correlated with unresectability of synchronous liver metastasis, both of which also indicated a worse long-term outcome of liver-metastasized PDAC patients after surgery. After the simultaneous resections, patients with post-operatively elevated serum CA125 levels had shorter survival than those with post-operatively reduced serum CA125 levels (7.7 mo vs 16.3 mo, P = 0.013). The survival of liver-metastasized PDAC patients who underwent the simultaneous resections was similar to that of non-metastasized PDAC patients who underwent curative pancreatectomy alone (7.0 mo vs 16.9 mo, P < 0.001), with no higher rates of either pancreatic fistula (P = 0.072) or other complications (P = 0.230) and no greater impacts on length of hospital stay (P = 0.602) or post-operative diabetic control (P = 0.479). The criterion set up by CA125 levels could facilitate careful diagnosis of synchronous liver metastases from PDAC, and prudent selection of appropriate patients for the simultaneous resections.
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影响因子：
--
作者：
Elias, Dominique;Di Pietroantonio, Danielo;De Baere, Thierry
通讯作者：
De Baere, Thierry
DOI：
10.1016/j.ijrobp.2010.10.011
发表时间：
2011-12-01
影响因子：
7
作者：
Kim, Tae Hyun;Han, Sung-Sik;Park, Joong-Won
通讯作者：
Park, Joong-Won
影响因子：
6.2
作者：
Gleisner, Ana Luiza;Assumpcao, Lia;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
9
作者：
De Jong, Mechteld C.;Farnell, Michael B.;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
9
作者：
Lillemoe, KD;Cameron, JL;Pitt, HA
通讯作者：
Pitt, HA