Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma - Is cure possible?
Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma - Is cure possible?
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DOI：
10.1097/sla.0b013e3181613142
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发表时间：
2008-03-01
影响因子：
9
通讯作者：
Farnell, Michael B.
中科院分区：
文献类型：
--
作者：
Schnelldorfer, Thomas;Ware, Adam L.;Farnell, Michael B.
目的：确定胰腺导管腺癌胰十二指肠切除术后的长期生存率，并确定与长期生存相关的临床因素。
背景资料概述：即使对胰腺腺癌进行了可能治愈的切除，其长期生存的预后也被认为是不佳的。胰腺切除术后决定短期生存的临床因素已得到充分研究，但预测有可能治愈的长期生存的预后因素却知之甚少。
方法：对1981年至2001年间因胰腺导管腺癌接受胰十二指肠切除术的357例患者进行了一项病例对照研究。对组织学标本进行重新分析以确认诊断。随访至少5年或直至死亡。
结果：在整个观察期间生存率有所提高（P = 0.004）。我们发现有62例实际的5年生存者，其中21例患者生存超过10年，5年和10年生存率分别为18%和13%。对短期（≤5年，n = 295）和长期（>5年，n = 62）生存患者进行队列分析显示，疾病更晚期（最大肿瘤直径、淋巴结转移）以及血清白蛋白浓度降低对长期生存不利（所有P < 0.05）。相反，切除范围和更具侵袭性的组织学特征与长期生存无关（所有P > 0.05）。整块切除（P = 0.005）而不是切缘状态（P > 0.05）与长期生存相关。辅助放化疗对长期生存没有显著影响。多变量分析确定淋巴结状态（比值比0.36，95%置信区间0.14 - 0.89，P = 0.03）是长期生存的一个预后因素。5年生存并不能保证治愈，因为该亚组中有16%的患者在术后长达7.8年死于胰腺癌。
结论：胰头腺癌的胰十二指肠切除术可使一部分患者获得长期生存，特别是在无淋巴结转移的情况下。八分之一的患者可实现10年生存且有可能治愈。
Objective: To determine long-term survival after pancreatoduodenectomy for pancreatic ductal adenocarcinoma and to identify clinical factors associated with long-term survival.Summary Background Data: The prognosis for long-term survival even after potentially curative resection for pancreatic adenocarcinoma is thought to be poor. Clinical factors determining short-term survival after pancreatic resection are well studied, but prognostic factors predicting long-term survival with a potential for cure are poorly understood.Methods: A case-control study was conducted of 357 patients who underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma between 1981 and 2001. Histologic specimens were reanalyzed to confirm diagnosis. Follow-up was at least 5 years or until death.Results: There was an improved survival throughout the observation period (P = 0.004). We found 62 actual 5-year survivors of whom 21 patients survived greater than 10 years, for a 5- and 10-year survival rate of 18% and 13%, respectively. Cohort analysis comparing patients with short-term (= 5 years, n = 62) survival showed that more advanced disease (greatest tumor diameter, lymph node metastasis) and decreased serum albumin concentration were unfavorable for long-term survival (all P < 0.05). In contrast, the extent of resection and more aggressive histologic features did not correlate with long-term survival (all P > 0.05). En-bloc resection (P = 0.005) but not resection margin status (P > 0.05) was associated with long-term survival. Adjuvant chemoradiation therapy did not significantly influence long-term survival. Multivariate analysis identified lymph node status (OR 0.36, 95% CI 0.14-0.89, P = 0.03) as a prognostic factor for long-term survival. Five-year survival was no guarantee of cure because 16% of this subset died of pancreatic cancer up to 7.8 years after operation.Conclusion: Pancreatoduodenectomy for adenocarcinoma in the head of pancreas can provide long-term survival in a subset of patients, particularly in the absence of lymph node metastasis. One of 8 patients can achieve 10-year survival with a potential for cure.