A Prospective Comparison of the Prognostic Value of Tumor- and Patient-Related Factors in Patients Undergoing Potentially Curative Surgery for Pancreatic Ductal Adenocarcinoma
A Prospective Comparison of the Prognostic Value of Tumor- and Patient-Related Factors in Patients Undergoing Potentially Curative Surgery for Pancreatic Ductal Adenocarcinoma
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DOI：
10.1245/s10434-011-1560-3
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发表时间：
2011-08-01
影响因子：
3.7
通讯作者：
McMillan, Donald C.
中科院分区：
文献类型：
--
作者：
Jamieson, Nigel B.;Denley, Simon M.;McMillan, Donald C.
胰腺导管腺癌根治性切除术后的预后预测仍然是一个挑战。越来越多的证据表明，持续的全身炎症反应的存在与接受各种常见实体瘤切除术的患者的不良结局相关。我们的目的是前瞻性地评估肿瘤和患者相关因素（包括全身炎症反应）对接受胰腺导管腺癌根治性手术患者的预后价值。（改良格拉斯哥预后评分[mGPS]），在2002年1月至2009年4月期间对135例因胰腺导管腺癌接受选择性胰腺切除术的患者进行了前瞻性研究。相关病理因素（特别是切缘受累;风险比[HR] 2.82，95%可信区间[CI] 1.65-4.84，P < 0.001），mGPS升高（HR 2.26，95% CI 1.43-3.57，P < 0.001）与胰腺癌切除术后较低的总生存率独立相关。此外，在74例患者的辅助治疗亚组中，切缘受累和mGPS升高均与总生存率降低独立相关。切缘受累和术前mGPS是行潜在治愈性胰腺炎切除术患者总生存率的最重要决定因素。此外，在接受辅助化疗的患者中，两者均具有独立的预后价值。将来，这可能会被视为进入治疗试验的分层因素。
Outcome prediction after resection with curative intent for pancreatic ductal adenocarcinoma remains a challenge. There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor outcome in patients undergoing resection for a variety of common solid tumors. Our aim was to prospectively evaluate the prognostic value of tumor- and patient-related factors including the systemic inflammatory response in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma of the head of pancreas.The prognostic impact of tumor factors such as stage and host factors, including the systemic inflammatory response (modified Glasgow Prognostic Score [mGPS]), were evaluated in a prospective study of 135 patients who underwent elective pancreaticoduodenectomy for pancreatic ductal adenocarcinoma from January 2002 to April 2009.In addition to the established tumor-related pathological factors (in particular margin involvement; hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.65-4.84, P < 0.001), an elevated mGPS (HR 2.26, 95% CI 1.43-3.57, P < 0.001) was independently associated with lower overall survival after pancreaticoduodenectomy. Additionally, in an adjuvant therapy subgroup of 74 patients, both margin involvement and an elevated mGPS remained independently associated with reduced overall survival.We have prospectively validated the influence of tumor-related and patient-related factors. Margin involvement and the preoperative mGPS were the most important determinants of overall survival in patients undergoing potentially curative pancreaticoduodenectomy. Furthermore, both had independent prognostic value in those patients receiving adjuvant chemotherapy. In the future, this may be considered a stratification factor for entry onto therapeutic trials.