Are Staging Computed Tomography (CT) Scans of the Chest Necessary in Pancreatic Adenocarcinoma?
Are Staging Computed Tomography (CT) Scans of the Chest Necessary in Pancreatic Adenocarcinoma?
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DOI：
10.1245/s10434-018-6764-3
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发表时间：
2018-12-01
影响因子：
3.7
通讯作者：
Ferrone, Cristina R.
中科院分区：
文献类型：
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作者：
Mehtsun, Winta T.;Chipidza, Fallon E.;Ferrone, Cristina R.
背景对于胸部影像学在胰腺导管腺癌（PDAC）患者中的应用尚未达成共识。在 PDAC 患者中，我们随着时间的推移检查了胸部计算机断层扫描 (CT) 的使用情况，并通过识别不确定的肺结节 (ILN) 来确定胸部 CT 的使用是否会导致生存差异或治疗改变。方法收集了 1998 年至 2014 年诊断为 PDAC 的患者的回顾性临床数据。我们检查了接受分期胸部 CT 扫描的患者与患有 ILN 的患者的比例， 定义为 1 个边界清晰、直径为 1 厘米的非钙化肺结节。我们使用多元 Cox 回归确定总生存时间 (OS)。我们还评估了后来仅发生肺转移的 PDAC 患者的治疗变化。结果 在 2710 名诊断为 PDAC 的患者中，632 名 (23%) 进行了超过 1 次胸部 CT 检查。在这些患者中，451 名 (71%) 患者有 ILN，而 181 名 (29%) 患者没有 ILN。没有 ILN 的患者（16.4 [13.6, 19.0] 个月）与有 ILN 的患者（14.8 [13.6, 15.8] 个月，P=0.18）的中位总生存期没有差异。通过检查发生孤立性肺转移的患者 (3.3%)，我们发现胸部 CT 分期不会导致原发腹部肿瘤治疗的改变。 结论 与没有分期胸部 CT 识别出 ILN 的 PDAC 患者相比，在分期胸部 CT 上发现 ILN 的 PDAC 患者的生存率没有差异。此外，ILN 的识别并没有导致原发性腹部肿瘤治疗的改变，质疑胸部 CT 分期对 PDAC 患者的实用性。
BackgroundThere is no consensus on the use of chest imaging in pancreatic ductal adenocarcinoma (PDAC) patients. Among PDAC patients, we examined the use of chest computed tomography (CT) over time and determined whether the use of chest CT led to a survival difference or change in management via identification of indeterminate lung nodules (ILNs).MethodsRetrospective clinical data was collected for patients diagnosed with PDAC from 1998 to 2014. We examined the proportion of patients undergoing staging chest CT scan and those who had ILN, defined as1 well-defined, noncalcified lung nodule(s)1cm in diameter. We determined time to overall survival (OS) using multivariate Cox regression. We also assessed changes in management of PDAC patients who later developed lung metastasis only.ResultsOf the 2710 patients diagnosed with PDAC, 632 (23%) had greater than one chest CT. Of those patients, 451 (71%) patients had ILNs, whereas 181 (29%) had no ILNs. There was no difference in median overall survival in patients without ILNs (16.4 [13.6, 19.0] months) versus those with ILN (14.8 [13.6, 15.8] months, P=0.18). Examining patients who developed isolated lung metastases (3.3%), we found that staging chest CTs did not lead to changes in management of the primary abdominal tumor.ConclusionsSurvival did not differ for PDAC patients with ILNs identified on staging chest CTs compared with those without ILNs. Furthermore, ILN identification did not lead to changes in management of the primary abdominal tumor, questioning the utility of staging chest CTs for PDAC patients.