Cytoreductive Surgery for Pancreatic Cancer Improves Overall Outcome of Gemcitabine-Based Chemotherapy
Cytoreductive Surgery for Pancreatic Cancer Improves Overall Outcome of Gemcitabine-Based Chemotherapy
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DOI：
10.1097/mpa.0000000000000365
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发表时间：
2015-08-01
期刊：
影响因子：
2.9
通讯作者：
Pelzer, Uwe
中科院分区：
文献类型：
--
作者：
Bahra, Marcus;Pratschke, Johann;Pelzer, Uwe
目的 如今，对于局部晚期胰腺癌 (PA) 患者，胰十二指肠切除术也是可行的。关于姑息性胰腺切除术后继以吉西他滨为基础的化疗 (Cx) 的风险和生存分析数据有限。 方法 2000 年至 2009 年间，共有 45 名患者接受了初次肿瘤细胞减灭手术 (cS)（胰十二指肠切除术或全胰腺切除术），随后接受基于吉西他滨的 Cx (cS + Cx) 治疗晚期 PA。我们将 cS + Cx 组与 45 名同期患者进行 1:1 匹配，这些患者主要开始基于吉西他滨的姑息性 Cx 治疗，包括年龄、性别、体能状态和体重指数。总体而言，评估了生存率。结果 转移性患者的局部 R0 和 R1 切除率分别为 27% 和 27%。 33% 的患者为 R2 切除状态，无远处转移，而 13% 的患者为局部 R2 状态，伴有额外转移 (M1)。胰腺细胞减灭术和连续基于吉西他滨的 Cx 后的中位总生存期为 10.4 个月，而前期基于吉西他滨的 Cx 后的中位总生存期为 7.2 个月 (P = 0.009)。 R0/M1 患者的中位生存期为 14.4 个月，R2/M0 患者的中位生存期为 11.0 个月，而 R1/M1 和 R2/M1 患者的中位生存期分别为 7.3 个月和 6.1 个月。 结论 与主要接受姑息性 Cx 的匹配对照组患者相比，晚期 PA 患者在接受姑息性胰十二指肠切除术并随后进行 Cx 治疗后，总体生存期显着更长。
Objectives Pancreatoduodenectomy is feasible also in patients with locally advanced pancreatic adenocarcinoma (PA) nowadays. Data on risk and survival analysis of palliative pancreatic resections followed by gemcitabine-based chemotherapy (Cx) are limited.Methods Between 2000 and 2009, a total of 45 patients had primary cytoreductive surgery (cS) (pancreaticoduodenectomy or total pancreatectomy) followed by gemcitabine-based Cx (cS + Cx) for advanced PA. We matched 1:1 the cS + Cx group with 45 contemporaneous patients who primarily started palliative gemcitabine-based Cx for age, sex, performance status, and body mass index. Overall, survival was evaluated.Results Local R0 and R1 resection in metastatic patients was achieved in 27% and 27%, respectively. The R2 resection status without distant metastasis resulted in 33%, whereas 13% showed a local R2 status with additional metastasis (M1). Median overall survival was 10.4 months after cytoreductive pancreatic surgery and consecutive gemcitabine-based Cx versus 7.2 months after upfront gemcitabine-based Cx (P = 0.009). Median survival for R0/M1 patients was 14.4 months and 11.0 months for R2/M0 patients, whereas the median survival for R1/M1 and for R2/M1 patients was 7.3 months and 6.1 months, respectively.Conclusions Individual patients with advanced PA had a significantly longer overall survival after palliative pancreaticoduodenectomy followed by Cx than patients in a matched control group who underwent primarily palliative Cx.