背景:胰腺导管腺癌(PDAC)是一种致命的胃肠道恶性肿瘤。它主要发现于,并被诊断为,转移的晚期。作为PDAC的唯一潜在治疗方法,手术切除对这些患者的生存有不确定的影响.因此,我们旨在调查转移性PDAC(mPDAC)患者是否从手术中获益.方法:18个监测区域的胰腺癌患者,流行病学,对2000年至2018年的最终结果数据库进行了回顾性审查。根据美国癌症联合委员会(AJCC)使用了第八版暂存系统。采用倾向评分匹配来加强研究的可比性。通过限制平均生存时间(RMST)和Kaplan-Meier分析评估手术对生存的影响。结果:共有210名匹配良好的mPDAC患者被纳入研究。1年,3年,手术患者的5年总生存率(OS)为34.3%,15.2%,和11.0%,分别。1年,3年,这些患者的5年癌症特异性生存率(CSS)为36.1%,19.7%,14.2%,分别。RMST分析显示,接受手术的mPDAC患者的OS和CSS优于没有手术的患者(OS:9.49个月与6.45个月,p<0.01;CSS:9.76个月vs.6.54个月,p<0.01)。然而,亚组分析表明,这种统计学意义尤其存在于寡转移PDAC患者中,这是指在本研究中数量有限且集中于单个器官的转移。此外,手术被确定为患者长期预后的重要预测因子(OS:[HR,风险比]=0.48,95%CI:0.36−0.65,p<0.001;CSS:HR=0.45,95%CI:0.33−0.63,p<0.001)。最后,在本研究中,我们建立了一个列线图来预测个体是否适合手术治疗.结论:手术切除可显着延长寡转移PDAC患者的长期预后。这些见解可能会在很大程度上扩大mPDAC患者的管理。然而,在建议对这些患者进行手术治疗之前,应进行前瞻性临床试验.
Background: Pancreatic ductal adenocarcinoma (PDAC) is a type of lethal gastrointestinal malignancy. It is mainly discovered at, and diagnosed with, an advanced stage of metastasis. As the only potentially curative treatment for PDAC, surgical resection has an uncertain impact on the survival of these patients. As such, we aimed to investigate if patients with metastatic PDAC (mPDAC) benefit from surgery. Methods: Patients with pancreatic cancer in 18 registries of the Surveillance, Epidemiology, and End Results database between 2000 and 2018 were reviewed retrospectively. According to the American Joint Committee on Cancer (AJCC), the eighth edition staging system was utilized. Propensity score matching was applied to strengthen the comparability of the
study. The impact of surgery on survival was evaluated by restricted mean survival time (RMST) and Kaplan−Meier analysis. Results: A total of 210 well-matched mPDAC patients were included in the
study. The 1 year, 3 year, and 5 year overall survival (OS) of patients undergoing surgery was 34.3%, 15.2%, and 11.0%, respectively. The 1 year, 3 year, and 5 year cancer-specific survival (CSS) of these patients was 36.1%, 19.7%, and 14.2%, respectively. RMST analysis revealed that mPDAC patients with surgery had better OS and CSS than those without (OS: 9.49 months vs. 6.45 months, p < 0.01; CSS: 9.76 months vs. 6.54 months, p < 0.01). Nevertheless, subgroup analysis demonstrated that such statistical significance especially existed in oligometastatic PDAC patients, which refers to those metastases that were limited in number and concentrated to a single organ in this
study. Additionally, surgery was identified as a significant predictor for the long-term prognosis of patients (OS: [HR, hazard ratio] = 0.48, 95% CI: 0.36−0.65, p < 0.001; CSS: HR = 0.45, 95% CI: 0.33−0.63, p < 0.001). Lastly, a nomogram was established to predict whether an individual was suitable for surgical treatment in this
study. Conclusions: Surgical resection significantly prolonged the long-term prognosis of oligometastatic PDAC patients. Such insights might broaden the management of patients with mPDAC to a large extent. However, a prospective clinical
trial should be conducted before a recommendation of surgery in these patients.