Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma
Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma
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DOI：
10.1097/sla.0000000000002734
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发表时间：
2019-06-01
影响因子：
9
通讯作者：
He, Jin
中科院分区：
文献类型：
--
作者：
Groot, Vincent P.;Gemenetzis, Georgios;He, Jin
目的：为了建立一个循证的截止值，以区分早期和晚期复发，并比较两组之间的临床病理危险因素。摘要背景资料：胰腺导管腺癌切除术后“早期复发”的明确定义目前缺乏。方法：2000年至2013年期间接受胰腺切除术治疗胰腺导管腺癌的患者被纳入。排除标准为新辅助治疗和随访不完整。采用最小P值法评估无复发生存期的最佳截止值，根据后续预后将患者分为早期和晚期复发队列。早期复发的潜在危险因素进行了评估与logistic回归models.Results：纳入的957例患者中，204例（21.3%）在最后随访无复发。区分早期复发（n = 388，51.5%）和晚期复发（n = 365，48.5%）的最佳无复发生存期为12个月（P < 0.001）。早期复发患者的1年和2年复发后生存率分别为20%和6%，而晚期复发组分别为45%和22%（均P < 0.001）。早期复发的术前危险因素包括Charlson年龄-合并症指数>= 4（OR 1.65），计算机断层扫描显示肿瘤大小> 3.0 cm（OR 1.53）和CA 19-9 > 210 U/mL（OR 2.30）。术后危险因素包括肿瘤分化程度低（OR 1.66）、显微镜下淋巴管浸润（OR 1.70）、淋巴结比率> 0.2（OR 2.49）和CA 19-9 > 37 U/mL（OR 3.38）。辅助化疗（OR 0.28）和放化疗（OR 0.29）与早期复发的可能性降低。结论：无复发间隔12个月是区分早期和晚期复发的最佳阈值，根据随后的预后。
Objectives: To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups.Summary Background Data: A clear definition of "early recurrence'' after pancreatic ductal adenocarcinoma resection is currently lacking.Methods: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models.Results: Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index >= 4 (OR 1.65), tumor size > 3.0cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence.Conclusion: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.