Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy?
Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy?
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DOI：
10.1016/j.ejso.2016.06.398
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发表时间：
2016-10-01
期刊：
影响因子：
3.8
通讯作者：
Falconi, M.
中科院分区：
文献类型：
--
作者：
Crippa, S.;Bittoni, A.;Falconi, M.
背景：新的化疗方案提高了IV期胰腺导管腺癌的存活率，偶尔可以观察到肝转移的主要反应。本研究的目的是分析胰腺癌肝转移患者接受初次化疗的结果，并评估手术切除的结果。排除标准：有肝外转移的患者，东部合作肿瘤组的患者表现状态=3，单独接受支持性护理的患者。结果：127名患者被确定。28.5%的患者肝转移为单叶。化疗方案包括吉西他滨单独或联合其他药物(44%)，奥沙利铂、伊立替康、氟尿嘧啶和亚叶酸钙(FOLFIRINOX)(8%)，顺铂、吉西他滨加卡培他滨和表阿霉素(PEXG)或卡培他滨和多西他赛(PDXG)或表阿霉素和氟尿嘧啶(PEFG)(48%)。56例患者(44%)完全缓解(7%)或部分缓解(37%)。手术切除11例(8.5%)。整个队列的中位总生存期为11个月，部分/完全缓解者为15个月。在这个亚组中，接受切除的患者的中位生存期明显更长(46个月比11个月)(P<；0.0001)。多药化疗(BR：0.512)、手术切除(HR：0.360)、确诊时肝转移5例(HR：3.515)、CA19.9减灭率及基线的50%(BR：2.708)是影响总生存率的独立预测因素。结论：部分病例在化疗后可考虑手术切除伴或不伴肝脏残留病变，可提高生存率。(C)2016爱思唯尔有限公司、类似于癌症外科协会的BASO和欧洲外科肿瘤学学会。版权所有。
Background: New chemotherapeutic regimens have improved survival for stage IV pancreatic ductal adenocarcinoma and occasionally major response of liver metastases can be observed. Aim of this work is to analyze the outcomes of patients undergoing primary chemotherapy for liver metastases from pancreatic cancer and to evaluate the results of surgical resection.Methods: Retrospective analysis. Exclusion criteria: patients with extra-hepatic metastases, patients with Eastern Cooperative Oncology Group performance status >= 3, patients undergoing supportive care alone.Results: 127 patients were identified. Liver metastases were unilobar in 28.5% of patients. Chemotherapy regimens included gemcitabine alone or in association with other agents (44%), oxaliplatin, irinotecan, fluorouracil and leucovorin (FOLFIRINOX 8%), and cisplatin, gemcitabine plus capecitabine and epirubicin (PEXG) or capecitabine and docetaxel (PDXG) or epirubicin and fluorouracil (PEFG) (48%). 56 patients (44%) had a complete (7%) or partial response (37%). surgical resection was carried out in 11 patients (8.5%). Median overall survival was 11 months for the entire cohort and 15 months for those with partial/complete response. In this sub-group median survival was significantly longer (46 versus 11 months) for patients undergoing resection (P < 0.0001). Independent predictors of overall survival were chemotherapy with multiple agents (BR: 0.512), surgical resection (HR: 0.360), >5 liver metastases at diagnosis (HR: 3.515), and CA 19.9 reduction < 50% of baseline value (BR: 2.708).Conclusions: Surgical resection of primary Pancreatic tumor with or without residual liver disease can be considered in selected cases after primary chemotherapy and it is associated with improved survival. (C) 2016 Elsevier Ltd, BASO similar to the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.