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首页> 外文期刊>Journal of Surgical Oncology >Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?
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Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?

机译：术前治疗是否可以使可切除的胰腺癌患者的结局达到最佳？

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The objective of this study was to compare survival between all patients with radiographically resectable adenocarcinoma of the proximal pancreas who underwent preoperative chemoradiation therapy (PRE-OP CRT) or surgical exploration first (SURGERY) with "intention to resect." Pancreatic cancer patients who undergo resection after PREOP CRT live longer than patients who undergo resection without PREOP CRT, a difference that may be attributable to patient selection. We retrospectively identified 236 patients with pancreatic head adenocarcinoma seen between 1999 and 2007 with sufficient data to be confirmed medically and radiographically resectable. The outcomes of 144 patients who underwent PREOP CRT were compared to those of 92 patients who proceeded straight to SURGERY. The groups were similar in age and gender. Tumors were slightly larger in the PREOP CRT group (mean 2.5 cm vs. 2.1 cm, P < 0.01), and there were trends toward more venous abutment (54% vs. 39%, P = 0.06) and a higher Charlson comorbidity index (P = 0.1). In the PREOP CRT group, 76 patients (53%) underwent resection, 28 (19%) had metastatic and 17 (12%) locally unresectable disease after PREOP CRT, and 23 (16%) were not explored due to performance status or loss to follow-up. In the SURGERY group, 68 patients (74%) underwent resection. Sixteen patients (17%) had metastatic and eight patients (9%) locally unresectable disease at exploration. In patients who underwent resection, the PREOP CRT group had smaller pathologic tumor size and lower incidence of positive lymph nodes than the SURGERY group but no difference in positive margins or need for vascular resection. Median overall survival (OS) in patients undergoing resection was 27 months in the PREOP CRT group and 17 months in the SURGERY group (P = 0.04). Median OS in all patients treated with PREOP CRT or surgically explored with intention to resect was 15 and 13 months, respectively, with superimposable survival curves. Despite a lower resection rate, the PREOP CRT group as a whole had a similar OS to the SURGERY group as a whole. For patients who underwent resection, those in the PREOP CRT had longer survival than those in the SURGERY group, suggesting that PREOP CRT allows better patient selection for resection. PREOP CRT should be considered an acceptable alternative for most patients with resectable pancreatic cancer.
机译：这项研究的目的是比较所有接受了术前化学放疗（PRE-OP CRT）或首先行外科探查（SURGERY）并有“切除意向”的放射学上可切除的胰腺近端腺癌患者的生存率。在进行PREOP CRT后进行切除的胰腺癌患者比未经PREOP CRT进行切除的患者活得更长，这可能归因于患者的选择。我们回顾性地鉴定了1999年至2007年间见到的236例胰头腺癌患者，并有足够的数据可以通过医学和影像学方法切除。将144例行PREOP CRT的患者与92例直接进行手术的患者的结果进行比较。两组的年龄和性别相似。 PREOP CRT组的肿瘤稍大些（平均2.5 cm对2.1 cm，P <0.01），并且有更多的静脉基台发生趋势（54％对39％，P = 0.06）和更高的Charlson合并症指数（ P = 0.1）。在PREOP CRT组中，有76例（53％）接受了切除术，在进行PREOP CRT后有转移的28例（19％）和17例（12％）的局部无法切除的疾病，以及由于表现状态或丢失而未探查的23例（16％）去跟随。在外科手术组中，有68例患者（74％）接受了切除术。探查时有16例患者（17％）有转移，而8例患者（9％）有局部不可切除的疾病。在接受手术切除的患者中，与手术组相比，PREOP CRT组的病理肿瘤尺寸较小，阳性淋巴结发生率较低，但阳性切缘无差异或需要进行血管切除。在PREOP CRT组中，接受切除手术的患者的中位总体生存期（OS）为27个月，在手术组中为17个月（P = 0.04）。所有接受PREOP CRT治疗或手术切除的患者的OS中位数分别为15个月和13个月，具有可叠加的生存曲线。尽管切除率较低，但PREOP CRT组的总体操作系统与SURGERY组的总体操作系统相似。对于接受手术切除的患者，PREOP CRT患者的生存期比手术组的患者更长，这表明PREOP CRT可以为切除患者提供更好的选择。对于大多数可切除的胰腺癌患者，应考虑使用PREOP CRT。

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