Does the Extent of Resection Impact Survival for Duodenal Adenocarcinoma? Analysis of 1,611 Cases
Does the Extent of Resection Impact Survival for Duodenal Adenocarcinoma? Analysis of 1,611 Cases
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DOI：
10.1245/s10434-014-4020-z
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发表时间：
2015-02-01
影响因子：
3.7
通讯作者：
Poultsides, George A.
中科院分区：
文献类型：
--
作者：
Cloyd, Jordan M.;Norton, Jeffrey A.;Poultsides, George A.
由于十二指肠腺癌（DA）相对罕见，很少有研究调查切除类型对长期结局的影响。使用监测，流行病学和最终结果数据库识别1988年至2010年期间所有DA患者。根据接受的手术类型，患者分为两组：简单切除术（SR），定义为原发部位的简单切除，以及根治性切除术（RR），定义为原发部位的切除以及与其他器官的连续切除。比较了疾病特异性生存期（DSS）和总生存期（OS）的差异。在纳入的1,611例患者中，746例（46.3%）接受了SR，865例（53.7%）接受了RR。正如预期的那样，接受RR的患者更有可能出现低分化和大肿瘤，以及晚期疾病。尽管淋巴结（LN）切除率更高（11.0 vs. 6.8; p < 0.0001），但RR与生存率改善无关（SR的5年DSS和OS率分别为52.8和41.3%，RR为48.8和37.6%; p > 0.05）。在单变量考克斯比例风险回归分析中，手术类型与OS无关（比值比[OR] 0.98; 95%置信区间[CI] 0.87-1.11）。TNM分期越高、肿瘤分级越高、切除的淋巴结越少、淋巴结比率越高、无放射治疗与生存率越差相关。在控制混杂因素后，手术类型仍然不影响OS（OR 1.11; 95%CI 0.97-1.27）。与单纯节段性切除相比，
Because duodenal adenocarcinoma (DA) is relatively rare, few studies have investigated the impact of resection type on long-term outcomes.The Surveillance, Epidemiology, and End Results database was used to identify all patients between 1988 and 2010 with DA. Patients were divided into two groups based on the type of surgery received: simple resection (SR), defined as a simple removal of the primary site, and radical resection (RR), defined as removal of the primary site with a resection in continuity with other organs. Differences in disease-specific survival (DSS) and overall survival (OS) were compared.Of the 1,611 patients included, 746 (46.3 %) underwent SR and 865 (53.7 %) underwent RR. As expected, patients undergoing RR were more likely to present with poorly differentiated and large tumors, as well as advanced stage disease. Despite greater lymph node (LN) retrieval (11.0 vs. 6.8; p < 0.0001), RR was not associated with improved survival (5-year DSS and OS rates of 52.8 and 41.3 % for SR vs. 48.8 and 37.6 % for RR; p > 0.05). On univariate Cox proportional hazards regression analysis, the type of surgery was not associated with OS (odds ratio [OR] 0.98; 95 % confidence interval [CI] 0.87-1.11). Increasing TNM stages, tumor grade, fewer LNs removed, LN ratio, and absence of radiation were associated with worse survival. After controlling for confounding factors, type of surgery still did not influence OS (OR 1.11; 95 % CI 0.97-1.27).Radical resection (e.g., in the form of pancreaticoduodenectomy) does not appear to impact survival compared with simple segmental resection for DA.