Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial
Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial
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DOI：
10.1097/00000658-200112000-00007
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发表时间：
2001-12-01
影响因子：
9
通讯作者：
Büchler, MW
中科院分区：
文献类型：
--
作者：
Neoptolemos, JP;Stocken, DD;Büchler, MW
目的评估切除边缘对胰腺癌患者生存率的影响，在辅助欧洲胰腺癌研究组-1（ESPAC-1）study.Summary背景资料胰腺癌切除后的长期生存率仅为10%至15%。阳性显微镜下切除边缘（R1）的患者有一个更糟糕的生存，但它是不知道他们如何票价在辅助study.Methods ESPAC-1，最大的随机辅助研究可切除的胰腺癌以往任何时候都进行了，开始看看放化疗的作用。随机分组按切缘状态前瞻性分层。结果541例患者中位随访10个月，101例（19%）行R1切除。切缘状态被确认为影响预后的因素，R1患者的中位生存期为10.9个月，而R 0患者的中位生存期为16.9个月。在考克斯比例风险模型中，只有在没有肿瘤分级和淋巴结状态的情况下，切除边缘状态仍然是一个独立的因素。无论R 0/R1状态如何，化疗对生存有益处，而放化疗无益处。中位生存期为19.7个月化疗与14.0个月没有。对于R 0边缘的患者，化疗产生更长的生存期相比，没有化疗，这种差异是不太明显的较小的亚组的R1患者，但有没有显着的异质性之间的R 0和R1 groups.Conclusions切除边缘阳性胰腺肿瘤的生物学更具侵略性的癌症，这些患者受益于切除和辅助化疗，但不放化疗。与R 0界值患者相比，R1界值患者的化疗获益程度降低。R1肿瘤患者应纳入未来的辅助治疗试验，随机化和分析应根据这一重要的预后因素分层。
Objective To assess the influence of resection margins on survival for patients with resected pancreatic cancer treated within the context of the adjuvant European Study Group for Pancreatic Cancer-1 (ESPAC-1) study.Summary Background Data Pancreatic cancer is associated with a poor long-term survival rate of only 10% to 15% after resection. Patients with positive microscopic resection margins (R1) have a worse survival, but it is not known how they fare in adjuvant studies.Methods ESPAC-1, the largest randomized adjuvant study of resectable pancreatic cancer ever performed, set out to look at the roles of chemoradiation and chemotherapy. Randomization was stratified prospectively by resection margin statuResults Of 541 patients with a median follow-up of 10 months, 101 (19%) had R1 resections. Resection margin status was confirmed as an influential prognostic factor, with a median survival of 10.9 months for R1 versus 16.9 months months for patients with R0 margins. Resection margin status remained an independent factor in a Cox proportional hazards model only in the absence of tumor grade and nodal status, There was a survival benefit for chemotherapy but not chemoradiation, irrespective of R0/R1 status. The median survival was 19.7 months with chemotherapy versus 14.0 months without. For patients with R0 margins, chemotherapy produced longer survival compared with to no chemotherapy, This difference was less apparent for the smaller subgroup of R1 patients, but there was no significant heterogeneity between the R0 and R1 groups.Conclusions Resection margin-positive pancreatic tumors represent a biologically more aggressive cancer; these patients benefit from resection and adjuvant chemotherapy but not chemoradiation. The magnitude of benefit for chemotherapy treatment is reduced for patients with R1 margins versus those with R0 margins. Patients with R1 tumors should be included in future trials of adjuvant treatments and randomization and analysis should be stratified by this significant prognostic factor.