背景:胰腺导管闭塞可伴随胰头癌,导致胰腺外分泌功能不全(PEI)以及对营养状况和术后结局的不利影响。我们调查了它对营养状况的影响,身体成分,接受新辅助治疗(NAT)的胰头癌患者的术后结局。
方法:我们分析了2015年至2022年间在打算进行胰十二指肠切除术(PD)之前接受NAT的136例胰头癌患者。营养和人体测量指数(体重指数[BMI],白蛋白,预后营养指数[PNI],格拉斯哥预后评分,腰大肌指数,皮下脂肪组织指数[SATI],和内脏脂肪组织指数)和术后结果在闭塞(n=78)和非闭塞(n=58)组之间进行比较,其中61名和44名患者,分别,最终接受了PD。
结果:闭塞组显示出NAT后BMI明显降低,PNI,PD队列中的SATI(分别为p=0.011、0.005和0.015)。闭塞组主胰管明显增大,较小的胰腺实质,和更大的导管-实质比率(p<0.001),这些形态学参数与NAT后的营养和人体测量指标显着相关。术后3年生存率和无复发生存率(RFS)明显下降(p=0.004和0.013)与胰腺导管闭塞,也被确定为总生存期(风险比[HR]:2.31,95%置信区间[CI]1.08-4.94,p=0.030)和RFS(HR:2.03,95%CI1.10-3.72,p=0.023)的独立术后风险因素,在多变量分析中。
结论:由于PEI相关的营养不良,胰腺导管闭塞可能与术后预后较差有关。
BACKGROUND: Pancreatic ductal occlusion can accompany pancreatic head cancer, leading to pancreatic exocrine insufficiency (PEI) and adverse effects on nutritional status and postoperative outcomes. We investigated its impact on nutritional status, body composition, and postoperative outcomes in patients with pancreatic head cancer undergoing neoadjuvant therapy (NAT).
METHODS: We analyzed 136 patients with pancreatic head cancer who underwent NAT prior to intended pancreaticoduodenectomy (PD) between 2015 and 2022. Nutritional and anthropometric indices (body mass index [BMI], albumin, prognostic nutritional index [PNI], Glasgow prognostic score, psoas muscle index, subcutaneous adipose tissue index [SATI], and visceral adipose tissue index) and postoperative outcomes were compared between the occlusion (n = 78) and non-occlusion (n = 58) groups, in which 61 and 44 patients, respectively, ultimately underwent PD.
RESULTS: The occlusion group showed significantly lower post-NAT BMI, PNI, and SATI (p = 0.011, 0.005, and 0.015, respectively) in the PD cohort. The occlusion group showed significantly larger main pancreatic duct, smaller pancreatic parenchyma, and greater duct-parenchymal ratio (p < 0.001), and these morphological parameters significantly correlating with post-NAT nutritional and anthropometric indices. Postoperative 3-year survival and recurrence-free survival (RFS) rates were significantly poorer (p = 0.004 and 0.013) with pancreatic ductal occlusion, also identified as an independent postoperative risk factor for overall survival (hazard ratio [HR]: 2.31, 95% confidence interval [CI] 1.08-4.94, p = 0.030) and RFS (HR: 2.03, 95% CI 1.10-3.72, p = 0.023), in multivariate analysis.
CONCLUSIONS: Pancreatic ductal occlusion may be linked to poorer postoperative outcomes due to PEI-related malnutrition.