首页 > 期刊杂志 > 正文

Prognostic Significance of New AJCC Tumor Stage in Patients With Pancreatic Ductal Adenocarcinoma Treated With Neoadjuvant Therapy.

新的AJCC肿瘤分期在新辅助治疗后胰腺导管腺癌患者中的预后价值

Chatterjee D,Katz MH,Foo WC,Sundar M,Wang H,Varadhachary GR,Wolff RA,Lee JE,Maitra A,Fleming JB,Rashid A,Wang H

Abstract

The American Joint Committee for Cancer has adopted a size-based T stage system (eighth edition) for pancreatic ductal adenocarcinoma (PDAC), defined as follows: pT1≤2 cm (pT1a≤0.5 cm, pT1b>0.5 and<1 cm, and pT1c 1-2 cm); pT2>2 and ≤4 cm; and pT3> 4 cm. However, the prognostic value of this new T staging system has not been validated in patients who underwent pancreaticoduodenectomy (PD) after neoadjuvant therapy. In this study, we analyzed 398 PDAC patients who underwent neoadjuvant therapy and PD at our institution from 1999 to 2012. The results were correlated with clinicopathologic parameters and survival. The new T stage correlated with lymph nodes metastasis (P<0.001), tumor response grade (P<0.001), disease-free survival (DFS, P<0.001) and overall survival (OS, P<0.001). None of the patients with ypT0 had recurrence or died of disease. Among the patients with ypT1 disease, patients with ypT1a and ypT1b had better DFS (P=0.046) and OS (P=0.03) than those with ypT1c. However, there was no significant difference in either DFS or OS between ypT1c and ypT2 or between ypT2 and ypT3 groups (P>0.05). In multivariate analysis, new ypT3 stage was associated with shorter OS (P=0.04), but not DFS (P=0.16). Our results show that the new ypT stage better stratify survival than the ypT stage in American Joint Committee for Cancer seventh edition for PDAC patients who received PD after neoadjuvant therapy, and that tumor size cutoff of 1.0 cm work better for ypT2 than the proposed tumor size cutoff of 2.0 cm in this group of patients.

摘要

美国癌症联合会(AJCC)针对胰腺导管腺癌(PDAC)采用了一项以肿瘤大小为基准的T分期系统(第八版),定义如下:pT1≤2cm(pT1a≤0.5 cm,pT1b 0.5-1 cmpT1c 1-2 cm);pT2 2-4 cmpT3> 4 cm然而,这项新的T分期系统的预后价值还未在接受新辅助治疗并且行胰腺十二指肠切除术(PD)的患者中得到证实。在这项研究中,我们分析了从1999年到2012年在我们机构接受过新辅助治疗和PD的398例PDAC患者,结果与临床病理参数和预后相关。新的T分期与淋巴结转移(P<0.001),肿瘤反应等级(P<0.001),无病生存期(DFS,P<0.001)以及总体生存期(OS,P<0.001)相关。所有处于ypT0期的患者均未复发或死亡。在ypT1期的患者中,ypT1a期和ypT1b期患者的DFS(P=0.046)和OS(P=0.03)较ypT1c期更好。但是,在ypT1c和ypT2组中,两者无论是DFS还是OS均没有显著差别,ypT2 和ypT3组也如此(P>0.05)。在多变量分析中,新的ypT3期和更短的OS相关(P=0.04),与DFS则关联不大(P=0.16)。我们的数据显示在接受新辅助治疗后并行PD的PDAC患者中,新的ypT分期相较第七版的AJCC而言具有更佳的分层预后,并且对于这组患者的ypT2期而言,肿瘤大小1.0cm的分界值好过之前提出的2.0cm。








full text

我要评论

0条评论