Risk of Recurrence after Surgical Resection for Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasia (IPMN) with Patterns of Distribution and Treatment An International, Multicentre, Observational Study
Risk of Recurrence after Surgical Resection for Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasia (IPMN) with Patterns of Distribution and Treatment An International, Multicentre, Observational Study
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导管内乳头状粘液性肿瘤 (IPMN) 引起的腺癌手术切除后的复发风险及其分布和治疗模式 一项国际多中心观察性研究
DOI：
10.1097/sla.0000000000006144
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发表时间：
2023
影响因子：
9
通讯作者：
Lucocq J
中科院分区：
文献类型：
--
作者：
Lucocq J
目的：这项国际多中心队列研究旨在确定导管内乳头状粘液性肿瘤（IPMN）引起的腺癌胰腺切除术后的复发模式和首次和第二次复发的治疗。背景：IPMN引起的腺癌切除术后复发的复发模式和治疗尚不清楚。方法：2010年1月至2020年12月期间，在18个胰腺中心确定了因IPMN腺癌接受胰腺切除术的患者。使用Kaplan-Meier对数秩检验和Cox比例风险模型的多变量logistic回归进行生存分析。终点复发（时间，位置和复发模式）和生存（总生存率和调整治疗提供）。结果：459例患者（中位数，70岁;四分位数范围，64-76;男性，54%），中位数随访78.1个月。209例患者发生复发[45.5%;中位复发时间为12.8个月;早期复发（1年内），23.2%]。83例（18.1%）患者发生了局部区域复发，164例（35.7%）患者发生了远处复发。辅助化疗与减少复发无关（风险比1.09; P= 0.669）120例复发患者接受了进一步治疗。中位生存期分别为27.0和14.6个月（P< 0.001），治疗方式之间无显著差异。复发部位之间的生存率无显著差异（P= 0.401）。结论：胰腺癌切除术后IPMN引起的复发是频繁的，四分之一的患者在12个月内复发。复发的治疗与总生存率的改善相关，应予以考虑。
Objective:This international multicenter cohort study aims to identify recurrence patterns and treatment of first and second recurrence in a large cohort of patients after pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasm (IPMN).Background:Recurrence patterns and treatment of recurrence postresection of adenocarcinoma arising from IPMN are poorly explored.Methods:Patients undergoing pancreatic resection for adenocarcinoma from IPMN between January 2010 and December 2020 at 18 pancreatic centers were identified. Survival analysis was performed using the Kaplan-Meier log-rank test and multivariable logistic regression by Cox-Proportional Hazards modeling. End points were recurrence (time-to, location, and pattern of recurrence) and survival (overall survival and adjusted for treatment provided).Results:Four hundred fifty-nine patients were included (median, 70 years; interquartile range, 64–76; male, 54%) with a median follow-up of 78.1 months. Recurrence occurred in 209 patients [45.5%; median time to recurrence, 12.8 months; early recurrence (within 1 years), 23.2%]. Eighty-three (18.1%) patients experienced a local regional recurrence, and 164 (35.7%) patients experienced a distant recurrence. Adjuvant chemotherapy was not associated with reduction in recurrence (hazard ratio 1.09; P= 0.669) One hundred twenty patients with recurrence received further treatment. The median survival with and without additional treatment was 27.0 and 14.6 months (P< 0.001), with no significant difference between treatment modalities. There was no significant difference in survival between locations of recurrence (P= 0.401).Conclusions:Recurrence after pancreatic resection for adenocarcinoma arising from IPMN is frequent with a quarter of patients recurring within 12 months. Treatment of recurrence is associated with improved overall survival and should be considered.