Standardization of Surgical and Pathologic Variables is Needed in Multicenter Trials of Adjuvant Therapy for Pancreatic Cancer: Results from the ACOSOG Z5031 Trial
Standardization of Surgical and Pathologic Variables is Needed in Multicenter Trials of Adjuvant Therapy for Pancreatic Cancer: Results from the ACOSOG Z5031 Trial
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DOI：
10.1245/s10434-010-1282-y
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发表时间：
2011-02-01
影响因子：
3.7
通讯作者：
Pisters, Peter W. T.
中科院分区：
文献类型：
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作者：
Katz, Matthew H. G.;Merchant, Nipun B.;Pisters, Peter W. T.
手术和病理技术的标准化对于评估胰腺癌 (PC) 辅助治疗的研究的解释至关重要。为了评估患者参加辅助治疗试验之前所进行的治疗的质量控制程度，美国外科医师学会肿瘤学组 (ACOSOG) Z5031（一项全国化放疗试验）中患者的手术和病理报告 胰十二指肠切除术（PD）经过严格评估。我们分析了可能影响分期或结果的变量。对 80 名据报告接受过 R0 (75%) 或 R1 (25%)、保留幽门 (38%) 或标准 (62%) PD 的患者进行了评估。 96% 的病例均记录了转移灶的查找情况。据报道，肿瘤靠近肠系膜上静脉的比例为 69%； 9% 需要静脉切除术，14% 需要侧静脉缝合术。 68% 的人描述了沿肠系膜上动脉 (SMA) 的解剖方法，包括超声解剖 (17%)、吻合器 (24%) 和夹紧切割 (59%)。 25% 的人描述了 SMA 骨骼化，24% 的人记录了切除后没有疾病。外科医生报告将 SMA 临界边缘标记为 25%； 65% 的病例记录有墨迹，47% 的病例报告了 SMA 边缘评估。评估了 1-49 个淋巴结的范围。只有 34% 的病理报告符合美国病理学家学会的标准。PD 后辅助治疗的试验在患者入组前缺乏标准化和质量控制。这些数据表明多学科治疗方案的设计需要改进。
Standardization of surgical and pathologic techniques is crucial to the interpretation of studies evaluating adjuvant therapies for pancreatic cancer (PC).To assess the degree to which treatment administered prior to enrollment of patients in trials of adjuvant therapy is quality controlled, the operative and pathology reports of patients in American College of Surgeons Oncology Group (ACOSOG) Z5031-a national trial of chemoradiation following pancreaticoduodenectomy (PD)-were rigorously evaluated. We analyzed variables with the potential to influence staging or outcome.80 patients reported to have undergone R0 (75%) or R1 (25%) pylorus-preserving (38%) or standard (62%) PD were evaluated. A search for metastases was documented in 96% of cases. The proximity of the tumor to the superior mesenteric vein was reported in 69%; vein resection was required in 9% and lateral venorrhaphy in 14%. The method of dissection along the superior mesenteric artery (SMA) was described in 68%, being ultrasonic dissection (17%), stapler (24%), and clamp and cut (59%). SMA skeletonization was described in 25%, and absence of disease following resection was documented in 24%. The surgeon reported marking the critical SMA margin in 25%; inking was documented in 65% of cases and evaluation of the SMA margin was reported in 47%. A range of 1-49 lymph nodes was evaluated. Only 34% of pathology reports met College of American Pathologists criteria.Trials of adjuvant therapy following PD suffer from a lack of standardization and quality control prior to patient enrollment. These data suggest areas for improvement in the design of multidisciplinary treatment protocols.