Preoperative gemcitabine-based chemoradiation therapy for pancreatic ductal adenocarcinoma of the body and tail: Impact of splenic vessels involvement on operative outcome and pattern of recurrence
Preoperative gemcitabine-based chemoradiation therapy for pancreatic ductal adenocarcinoma of the body and tail: Impact of splenic vessels involvement on operative outcome and pattern of recurrence
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DOI：
10.1016/j.surg.2014.09.022
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发表时间：
2015-03-01
期刊：
影响因子：
3.8
通讯作者：
Ishikawa, Osamu
中科院分区：
文献类型：
--
作者：
Takahashi, Hidenori;Akita, Hirofumi;Ishikawa, Osamu
背景。在胰腺导管腺癌（PDA）的多种多模式治疗策略中，术前放化疗（CRT）和后续手术是一种有前景的策略。本研究的目的是评估术前基于吉西他滨的 CRT 对身体和尾部 FDA 的结果，重点关注脾血管受累、手术结果和复发模式之间的关联。方法。总共 99 例身体和尾部 FDA 患者接受了术前 CRT。根据开始术前 CRT 之前获得的影像学结果评估脾动脉（SA）和静脉（SV）肿瘤受累状态。我们评估了与 SA 和 SV 受累状态相关的以下内容：（1）切除率，（2）生存率，（3）复发模式。结果。 SA 阳性病例的切除率 (71%) 显着低于 SA 阴性病例 (94%；P = .004)，而 SV 受累与切除率无关。切除的SA阴性和SA阳性病例的5年生存率分别为76%和20%，<.001)。 SA 阳性患者的 5 年累积远处复发发生率显着高于 SA 阴性患者（74% vs 17%；P < .001）。结论。在体尾FDA术前CRT中，SA阳性受累者的切除率较低，且SA阳性肿瘤患者的生存率低于SA阴性肿瘤患者，因为SA阳性患者远处复发的发生率较高。
Background. Among the various multimodal treatment strategies for pancreatic ductal adenocarcinoma (PDA), preoperative chemoradiation therapy (CRT) and subsequent operation is a promising strategy. The aim of this study is to evaluate the outcome of preoperative gemcitabine-based CRT for FDA of the body and tail, focusing on the associations among splenic vessel involvement, surgical outcomes, and pattern of recurrence.Methods. A total of 99 patients with FDA of the body and tail received preoperative CRT The status of tumor involvement of the splenic artery (SA) and vein (SV) were evaluated based on radiographical findings obtained before the initiation of preoperative CRT We assessed the following in association with the status of SA and SV involvement: (1) resection rate, (2) survival, and (3) pattern of recurrence.Results. The resection rate of SA-positive cases (71%) was significantly lesser than that of SA-negative cases (94%; P = .004), whereas SV involvement was not associated with the resection rate. The 5-year survival rates of the resected SA-negative and SA-positive cases were 76% and 20%, respectively < .001). The 5-year cumulative incidence of distant recurrence was significantly higher in the SA-positive patients than in the SA-negative patients (74% vs 17%; P < .001).Conclusion. In preoperative CRT for FDA of the body and tail, positive SA involvement was associated with a lesser resection rate, and the survival rate for the patients with SA-positive tumors was lesser than that for patients with SA-negative tumors because of the greater incidence of distant recurrence in SA-positive patients.