{"title":"胰腺尾部可切除胰腺导管腺癌胰腺外器官侵犯的预后影响","authors":"","doi":"10.1016/j.ejrad.2024.111715","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>To assess the prognostic significance of extra-pancreatic organ invasion in patients with resectable pancreatic ductal adenocarcinoma (PDAC) in the pancreas tail.</p></div><div><h3>Materials & Methods</h3><p>This retrospective study included patients with resectable PDAC in the pancreas tail who received upfront surgery between 2014 and 2020 at a tertiary institution. Preoperative pancreas protocol computed tomography (CT) scans evaluated tumor size, peripancreatic tumor infiltration, suspicious metastatic lymph nodes, and extra-pancreatic organ invasion. The influence of extra-pancreatic organ invasion, detected by CT or postoperative pathology, on pathologic resection margin status was evaluated using logistic regression. The impact on recurrence-free survival (RFS) was analyzed using multivariable Cox proportional hazard models (clinical-CT and clinical-pathologic).</p></div><div><h3>Results</h3><p>The study included 158 patients (mean age, 65 years ± 8.8 standard deviation; 93 men). Extra-pancreatic organ invasion identified by either CT (<em>p</em> = 0.92) or pathology (<em>p</em> = 0.99) was not associated with a positive resection margin. Neither CT (<em>p</em> = 0.42) nor pathological (<em>p</em> = 0.64) extra-pancreatic organ invasion independently correlated with RFS. Independent predictors for RFS included suspicious metastatic lymph node (hazard ratio [HR], 2.05; 95 % confidence interval [CI], 1.08–3.9; <em>p</em> = 0.03) on CT in the clinical-CT model, pathological T stage (HR, 2.97; 95 % confidence interval [CI], 1.39–6.35; <em>p</em> = 0.005 for T2 and HR, 3.78; 95 % CI, 1.64–8.76; <em>p</em> = 0.002 for T3) and adjuvant therapy (HR, 0.62; 95 % confidence interval [CI], 0.42–0.92; <em>p</em> = 0.02) in the clinical-pathologic model.</p></div><div><h3>Conclusion</h3><p>Extra-pancreatic organ invasion does not independently influence pathologic resection margin status and RFS in patients with resectable PDAC in the pancreas tail after curative-intent resection; therefore, it should not be considered a high-risk factor.</p></div>","PeriodicalId":12063,"journal":{"name":"European Journal of Radiology","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic implication of extra-pancreatic organ invasion in resectable pancreas ductal adenocarcinoma in the pancreas tail\",\"authors\":\"\",\"doi\":\"10.1016/j.ejrad.2024.111715\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>To assess the prognostic significance of extra-pancreatic organ invasion in patients with resectable pancreatic ductal adenocarcinoma (PDAC) in the pancreas tail.</p></div><div><h3>Materials & Methods</h3><p>This retrospective study included patients with resectable PDAC in the pancreas tail who received upfront surgery between 2014 and 2020 at a tertiary institution. Preoperative pancreas protocol computed tomography (CT) scans evaluated tumor size, peripancreatic tumor infiltration, suspicious metastatic lymph nodes, and extra-pancreatic organ invasion. The influence of extra-pancreatic organ invasion, detected by CT or postoperative pathology, on pathologic resection margin status was evaluated using logistic regression. The impact on recurrence-free survival (RFS) was analyzed using multivariable Cox proportional hazard models (clinical-CT and clinical-pathologic).</p></div><div><h3>Results</h3><p>The study included 158 patients (mean age, 65 years ± 8.8 standard deviation; 93 men). Extra-pancreatic organ invasion identified by either CT (<em>p</em> = 0.92) or pathology (<em>p</em> = 0.99) was not associated with a positive resection margin. Neither CT (<em>p</em> = 0.42) nor pathological (<em>p</em> = 0.64) extra-pancreatic organ invasion independently correlated with RFS. Independent predictors for RFS included suspicious metastatic lymph node (hazard ratio [HR], 2.05; 95 % confidence interval [CI], 1.08–3.9; <em>p</em> = 0.03) on CT in the clinical-CT model, pathological T stage (HR, 2.97; 95 % confidence interval [CI], 1.39–6.35; <em>p</em> = 0.005 for T2 and HR, 3.78; 95 % CI, 1.64–8.76; <em>p</em> = 0.002 for T3) and adjuvant therapy (HR, 0.62; 95 % confidence interval [CI], 0.42–0.92; <em>p</em> = 0.02) in the clinical-pathologic model.</p></div><div><h3>Conclusion</h3><p>Extra-pancreatic organ invasion does not independently influence pathologic resection margin status and RFS in patients with resectable PDAC in the pancreas tail after curative-intent resection; therefore, it should not be considered a high-risk factor.</p></div>\",\"PeriodicalId\":12063,\"journal\":{\"name\":\"European Journal of Radiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0720048X24004315\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Radiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0720048X24004315","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
目的评估胰腺尾部可切除胰腺导管腺癌(PDAC)患者胰腺外器官侵犯的预后意义:这项回顾性研究纳入了2014年至2020年间在一家三级医院接受前期手术的胰腺尾部可切除PDAC患者。术前胰腺方案计算机断层扫描(CT)评估了肿瘤大小、胰周肿瘤浸润、可疑转移淋巴结和胰外器官侵犯。利用逻辑回归评估了 CT 或术后病理检测到的胰腺外器官侵犯对病理切除边缘状态的影响。使用多变量 Cox 比例危险模型(临床-CT 和临床-病理)分析了对无复发生存率(RFS)的影响:研究共纳入 158 名患者(平均年龄 65 岁 ± 8.8 标准差;93 名男性)。CT(p = 0.92)或病理(p = 0.99)发现的胰腺外器官侵犯与切除边缘阳性无关。CT(p = 0.42)或病理(p = 0.64)发现的胰腺外器官侵犯均与RFS无关。RFS的独立预测因素包括临床-CT模型中CT显示的可疑转移淋巴结(危险比[HR],2.05;95%置信区间[CI],1.08-3.9;p = 0.03)、病理T分期(HR,2.97; 95 % confidence interval [CI], 1.39-6.35; p = 0.005 for T2 and HR, 3.78; 95 % CI, 1.64-8.76; p = 0.002 for T3)和辅助治疗(HR, 0.62; 95 % confidence interval [CI], 0.42-0.92; p = 0.02):胰腺外器官侵犯不会独立影响胰腺尾部可切除PDAC患者治愈性切除术后的病理切缘状态和RFS,因此不应将其视为高危因素。
Prognostic implication of extra-pancreatic organ invasion in resectable pancreas ductal adenocarcinoma in the pancreas tail
Objectives
To assess the prognostic significance of extra-pancreatic organ invasion in patients with resectable pancreatic ductal adenocarcinoma (PDAC) in the pancreas tail.
Materials & Methods
This retrospective study included patients with resectable PDAC in the pancreas tail who received upfront surgery between 2014 and 2020 at a tertiary institution. Preoperative pancreas protocol computed tomography (CT) scans evaluated tumor size, peripancreatic tumor infiltration, suspicious metastatic lymph nodes, and extra-pancreatic organ invasion. The influence of extra-pancreatic organ invasion, detected by CT or postoperative pathology, on pathologic resection margin status was evaluated using logistic regression. The impact on recurrence-free survival (RFS) was analyzed using multivariable Cox proportional hazard models (clinical-CT and clinical-pathologic).
Results
The study included 158 patients (mean age, 65 years ± 8.8 standard deviation; 93 men). Extra-pancreatic organ invasion identified by either CT (p = 0.92) or pathology (p = 0.99) was not associated with a positive resection margin. Neither CT (p = 0.42) nor pathological (p = 0.64) extra-pancreatic organ invasion independently correlated with RFS. Independent predictors for RFS included suspicious metastatic lymph node (hazard ratio [HR], 2.05; 95 % confidence interval [CI], 1.08–3.9; p = 0.03) on CT in the clinical-CT model, pathological T stage (HR, 2.97; 95 % confidence interval [CI], 1.39–6.35; p = 0.005 for T2 and HR, 3.78; 95 % CI, 1.64–8.76; p = 0.002 for T3) and adjuvant therapy (HR, 0.62; 95 % confidence interval [CI], 0.42–0.92; p = 0.02) in the clinical-pathologic model.
Conclusion
Extra-pancreatic organ invasion does not independently influence pathologic resection margin status and RFS in patients with resectable PDAC in the pancreas tail after curative-intent resection; therefore, it should not be considered a high-risk factor.
期刊介绍:
European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field.
Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.