结节阳性胰腺癌患者边缘间隙大于 1 毫米:多中心回顾性分析。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-07-02 DOI:10.1093/bjsopen/zrae076
Reea P Ahola, Eline S Zwart, Benediktas Kurlinkus, Asif Halimi, Bengi S Yilmaz, Giulio Belfiori, Keith Roberts, Rupaly Pande, Hasan A Al-Saffar, Patrick Maisonneuve, Güralp O Ceyhan, Johanna Laukkarinen
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引用次数: 0

摘要

背景:根据《利兹病理学协议》(Leeds Pathology Protocol),切除边缘的临界值为 1 毫米,这改变了手术根治性的概念。其对结节阳性胰腺导管腺癌切除患者的影响尚不明确。本研究的目的是分析根据利兹病理学方案分析标本的切除、结节阳性胰腺导管腺癌患者的边缘清除率对生存率的影响:从多中心临床数据库中回顾性收集数据。包括结节受累的切除患者。根据报告的最小边缘净度 0、0.5、1 和 2 毫米对总生存率和无病生存率进行分析。对于未进行静脉切除术的患者和有肠系膜上静脉切缘或静脉标本数据的患者,结果将分别进行报告。采用的是 AJCC 的第八版 TNM 分类法:研究包括 290 例 IIB 期患者和 215 例未进行静脉切除的 III 期患者。肠系膜上静脉切缘分析包括 127 例 IIB 期患者和 198 例 III 期患者。在未进行静脉切除的患者中,不同的切除边缘距离与总生存率和无病生存率无关(P > 0.050)。接受辅助治疗与IIB期患者(P = 0.034)和III期患者(P = 0.003)较长的总生存期有关,与III期患者较长的无病生存期有关(P < 0.001):在这项研究中,边缘间隙大于1毫米对结节受累的胰腺导管腺癌患者的总生存率没有明显影响,而辅助治疗被证实对确保延长总生存率至关重要。
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Margin clearance greater than 1 mm in nodal-positive pancreatic adenocarcinoma patients: multicentre retrospective analysis.

Background: The introduction of the 1 mm cut-off for resection margin according to the Leeds Pathology Protocol has transformed the concept of surgical radicality. Its impact on nodal-positive resected pancreatic ductal adenocarcinoma patients is unclear. The aim of this study was to analyse the effect of margin clearance on survival among resected, nodal-positive pancreatic ductal adenocarcinoma patients whose specimens were analysed according to the Leeds Pathology Protocol.

Methods: Data were collected retrospectively from multicentre clinical databases. Resected patients with nodal involvement were included. Overall survival and disease-free survival were analysed according to minimum reported margin clearances of 0, 0.5, 1, and 2 mm. The results are reported separately for patients who had not undergone venous resection and for patients for whom data were available regarding the superior mesenteric vein-facing margin or the vein specimen. The eighth edition of TNM classification by the AJCC was used.

Results: The study comprised 290 stage IIB patients and 215 stage III patients without venous resection. The superior mesenteric vein margin analysis comprised 127 stage IIB patients and 198 stage III patients. The different resection margin distances were not associated with overall survival and disease-free survival among patients without venous resection (P > 0.050). Receiving adjuvant therapy was associated with longer overall survival among stage IIB patients (P = 0.034) and stage III patients (P = 0.003) and with longer disease-free survival among stage III patients (P < 0.001).

Conclusions: In this study, a margin clearance greater than 1 mm showed no clear effect on overall survival in pancreatic ductal adenocarcinoma patients with nodal involvement, whereas adjuvant therapy was confirmed to be essential to ensure longer overall survival.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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