摘要
目的探讨不同策略治疗胰腺癌伴同时性肝转移(sLMPC)患者的临床效果。方法回顾性分析2017年4月至2022年12月连续在中日友好医院肝胆胰外科治疗的37例sLMPC患者的病历资料。男性23例,女性14例;年龄[M(IQR)]61(10)岁(范围:45~74岁)。明确诊断后给予全身系统化疗。初始化疗方案选择改良FOLFIRINOX、白蛋白紫杉醇联合吉西他滨、多西他赛+顺铂+氟尿嘧啶或吉西他滨+替吉奥方案等,初始化疗失败后更改化疗方案,经系统治疗后判定是否达到可以手术治疗的标准。使用Kaplan-Meier法计算总体生存时间及生存率;采用Log-rank检验和Gehan-Breslow-Wilcoxon检验比较生存曲线的差异。结果37例sLMPC患者的中位随访时间39个月,中位总体生存时间为13个月(范围:2~64个月),1、3、5年总体生存率分别为59.5%、14.7%、14.7%。36例患者初始接受系统化疗,其中29例患者完成4个周期以上的化疗,部分缓解15例、疾病稳定10例、疾病进展4例,肿瘤控制率为69.4%。在初始以转化手术为目的的24例患者中,转化成功率为54.2%(13/24)。13例转化成功患者中,9例选择手术,其治疗结果优于未手术的4例患者(中位生存时间未达到比中位生存时间13个月,P<0.05)。而转化未成功的9例患者中,手术组(4例)和未手术组(5例)的中位生存时间差异无统计学意义(P>0.05)。在接受手术治疗的13例患者中,转化有效组患者CA19-9水平降幅及肝转移灶退缩比例较转化无效组更为显著(P值均<0.05),但两组原发灶的变化差异无统计学意义(P>0.05)。结论高选择性sLMPC患者在系统治疗达部分缓解后,采取积极的手术治疗策略可能延长患者的生存时间,而系统化疗未达到缓解的患者,手术治疗并未给患者带来生存获益。
Objective To explore the outcome of different treatment strategies in patients with pancreatic cancer with synchronous liver metastasis(sLMPC).Methods A retrospective analysis of the clinical data and treatment results of 37 patients with sLMPC treated in China-Japan Friendship Hospital was performed from April 2017 to December 2022.A total of 23 males and 14 females were included,with an age(M(IQR))of 61(10)years(range:45 to 74 years).Systemic chemotherapy was carried out after pathological diagnosis.The initial chemotherapy strategy included modified-Folfirinox,albumin paclitaxel combined with Gemcitabine,and Docetaxel+Cisplatin+Fluorouracil or Gemcitabine with S1.The possibility of surgical resection(reaching the standards of surgical intervention)was determined after systemic treatment,and the chemotherapy strategy was changed in the cases of failed initial chemotherapy plans.The Kaplan-Meier method was used to estimate the overall survival time and rate,while Log-rank and Gehan-Breslow-Wilcoxon tests were used to compare the differences of survival curves.Results The median follow-up time for the 37 sLMPC patients was 39 months,and the median overall survival time was 13 months(range:2 to 64 months)with overall survival rates of 1-,3-,and 5-year of 59.5%,14.7%,and 14.7%,respectively.Of the 37 patients,97.3%(36/37)initially received systemic chemotherapy,29 completed more than four cycles,resulting in a disease control rate of 69.4%(partial response in 15 cases,stable disease in 10 cases,and progressive disease in 4 cases).In the 24 patients initially planned for conversion surgery,the successful conversion rate was 54.2%(13/24).Among the 13 successfully converted patients,9 underwent surgery and their treatment outcomes were significantly better than those(4 patients)of those who did not undergo surgery(median survival time not reached vs.13 months,P<0.05).Regarding the 9 patients whose conversion was unsuccessful,no significant differences were observed in median survival time between the surgical group(4 c
作者
黄笳
杨志英
隗瑞丽
Atyah Manar
孙永亮
徐力
周文颖
Huang Jia;Yang Zhiying;Wei Ruili;Atyah Manar;Sun Yongliang;Xu Li;Zhou Wenying(Department of Hepatobiliary and Pancreatic Surgery,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2023年第7期575-581,共7页
Chinese Journal of Surgery
基金
国家重点专科建设项目(2021-QTL-004)。
关键词
胰腺肿瘤
肿瘤转移
辅助化疗
手术治疗
生存时间
Pancreatic neoplasms
Neoplasm metastasis
Adjuvant chemotherapy
Surgical treatment
Overall survival time
