术前肿瘤大小对可切除和边缘可切除胰腺导管腺癌预后的影响。
Impact of Preoperative Tumor Size on Prognosis of Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinomas.
发表日期：2023 Sep 01
作者：
Yoichi Miyata, Naoto Yonamine, Ibuki Fujinuma, Takazumi Tsunenari, Yasuhiro Takihata, Hiroyuki Hakoda, Akiko Nakazawa, Toshimitsu Iwasaki, Takahiro Einama, Junichi Togashi, Hironori Tsujimoto, Hideki Ueno, Yoshifumi Beck, Yoji Kishi
来源：
ANNALS OF SURGICAL ONCOLOGY
摘要：
肿瘤大小（TS）是胰导管腺癌（PDAC）的已确立的预后因素。然而，无论TS如何，是否可以为所有可切除的R-PDAC和BR-PDAC患者应用统一的治疗策略仍然不清楚。本研究旨在研究术前TS对R-PDAC和BR-PDAC患者手术结果的影响。回顾了三个医疗机构的图表数据，选择了在2006年1月至2020年12月期间接受胰腺切除术治疗的R-PDAC和BR-PDAC患者。根据最小P值方法确定的R-PDAC和BR-PDAC的TS截断值，将患者分为TS小和TS大两组。在R-PDAC和BR-PDAC中，TS分别为35 mm和24 mm是最佳截断值。无论在R-PDAC（n = 35，37% vs n = 294，19%；P = 0.011）还是BR-PDAC（n = 89，37% vs n = 27，15%；P = 0.030）中，TS大组的R1切除率都较TS小组高。在R-PDAC中，整体生存期在TS小组明显优于TS大组（38.2 vs 12.1个月；P < 0.001），而在BR-DPAC中两组间相当（21.2 vs 22.7个月；P = 0.363）。多变量分析显示，TS > 35 mm是R-PDAC患者预后较差的独立预测因子。肿瘤大小较大与R-PDAC患者更高的R1切除率相关，并且是一个不良预后因素。© 2023. Society of Surgical Oncology.
Tumor size (TS) is a well-established prognostic factor of pancreatic ductal adenocarcinoma (PDAC). However, whether a uniform treatment strategy can be applied for all resectable PDACs (R-PDACs) and borderline resectable PDACs (BR-PDACs), regardless of TS, remains unclear. This study aimed to investigate the impact of preoperative TS on surgical outcomes of patients with R-PDACs and BR-PDACs.Chart data from three institutions were reviewed to select patients who underwent pancreatectomy for R-PDACs and BR-PDACs between January 2006 and December 2020. The patients were divided into TSsmall and TSlarge groups according to a TS cutoff value determined for each of R- and BR-PDAC using the minimum P value approach for the risk of R1 resection.TS of 35 mm and 24 mm was the best cutoff value in R-PDAC and BR-PDAC, respectively. The R1 rate was higher in the TSlarge than TSsmall group, in both R- (n = 35, 37% versus n = 294, 19%; P = 0.011) and BR-PDAC (n = 89, 37% versus n = 27, 15%; P = 0.030). Overall survival was significantly better in the TSsmall than TSlarge group in R-PDAC (38.2 versus 12.1 months; P < 0.001), but comparable between the two groups in BR-DPAC (21.2 versus 22.7 months; P = 0.363). Multivariate analysis revealed TS > 35 mm as an independent predictor of worse survival in patients with R-PDAC.Larger TS was associated with a higher R1 rate and is a worse prognostic factor in patients with R-PDAC.© 2023. Society of Surgical Oncology.