Predictive factors for early recurrence after pancreaticoduodenectomy in patients with resectable pancreatic head cancer: A multicenter retrospective study
Predictive factors for early recurrence after pancreaticoduodenectomy in patients with resectable pancreatic head cancer: A multicenter retrospective study
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DOI：
10.1016/j.surg.2022.08.004
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发表时间：
2022-11-18
期刊：
影响因子：
3.8
通讯作者：
Eguchi, Susumu
中科院分区：
文献类型：
--
作者：
Ono, Shinichiro;Adachi, Tomohiko;Eguchi, Susumu
背景：诊断为可切除胰腺导管腺癌的患者即使在前期 R0 切除后也经常出现早期复发。本研究旨在定义胰头可切除胰腺导管腺癌患者行前期胰十二指肠切除术后早期复发的定义，并确定术前早期复发的危险因素。方法：这项多中心、回顾性研究纳入了 2007 年至 2016 年间在 10 个机构接受胰十二指肠切除术的可切除胰头导管腺癌的 500 例患者。比较早期和非早期复发组的术前、术中和术后临床病理结果。使用统计分析确定早期复发的预测因素。结果：对数秩检验显示 3 至 6 个月内和 6 至 9 个月内复发之间存在显着差异 (P < .001)。随后将早期复发定义为6个月内复发。患者被分为早期复发组（n = 104）和非早期复发组（n = 389）。早期和非早期复发组的中位总生存期分别为 8.6 个月和 42.6 个月 (P < .001)。根据多变量分析，术前高碳水化合物抗原19-9水平≥120 U/mL、腹膜后浸润和糖尿病被确定为早期复发的独立预测危险因素。比较具有 3、2、1 个或没有这些因素的患者的生存率，中位总生存期分别为 17.6 (n = 90)、21.2 (n = 184)、47 (n = 141) 和 61.5 (n = 73) 个月。 结论：定义可切除胰头胰腺导管腺癌早期复发的最佳时期是 6 个月。肿瘤大小 >= 20 mm、术前碳水化合物抗原 19-9 水平 >= 120 U/mL、肿瘤腹膜后浸润以及糖尿病的存在与早期复发独立相关。(c) 2022 Elsevier Inc. 保留所有权利。
Background: Patients diagnosed with resectable pancreatic ductal adenocarcinoma often experience early recurrence even after upfront R0 resection. This study aimed to define early recurrence and identify preoperative risk factors for early recurrence after upfront pancreaticoduodenectomy in patients with resectable pancreatic ductal adenocarcinoma of the pancreatic head. Methods: This multicenter, retrospective study involved 500 patients who underwent pan-creaticoduodenectomy resectable pancreatic ductal adenocarcinoma of the pancreatic head at 10 in-stitutions between 2007 and 2016. Preoperative, intraoperative, and postoperative clinicopathological results were compared between early and non-early recurrence groups. Predictors of early recurrence were determined using statistical analyses.Results: Log-rank tests revealed a significant difference (P < .001) between recurrence within 3 to 6 months and 6 to 9 months. Early recurrence was subsequently defined as recurrence within 6 months. Patients were categorized into early recurrence (n = 104) and non-early recurrence groups (n = 389). The median overall survival of the early and non-early recurrence groups was 8.6 months and 42.6 months (P < .001), respectively. Preoperatively, high carbohydrate antigen 19-9 levels >= 120 U/mL, retroperitoneal invasion, and diabetes mellitus were identified as independent predictive risk factors for early recurrence according to multivariate analysis. Comparing survival rates among patients with 3, 2,1, or none of these factors, the median overall survival was 17.6 (n = 90), 21.2 (n = 184), 47 (n = 141), and 61.5 (n = 73) months, respectively.Conclusion: The optimal period that defines the early recurrence for resectable pancreatic ductal adenocarcinoma of the pancreatic head is 6 months. Tumor size >= 20 mm, preoperative carbohydrate antigen 19-9 levels >= 120 U/mL, retroperitoneal invasion of the tumor, and the presence of diabetes mellitus are independently associated with early recurrence.(c) 2022 Elsevier Inc. All rights reserved.