新辅助化疗对术中联合同种异体血管置换的交界可切除胰腺癌预后的影响

Impact of neoadjuvant chemotherapy on long-term prognosis for borderline resectable pancreatic cancer treated with combined allogeneic vascular replacement

目的评估术前新辅助化疗对手术切除联合同种异体血管置换术治疗的交界可切除胰腺癌患者预后的影响。方法回顾性分析2016年3月至2021年3月在首都医科大学附属北京朝阳医院治疗的交界可切除胰腺癌患者的资料,共纳入52例行联合同种异体血管置换的根治性手术治疗患者,其中男性24例,女性28例,年龄(60.3±10.6)岁。依据患者术前是否行新辅助化疗分为新辅助化疗组19例和单纯血管置换组33例。采用门诊复查及电话随访相结合的方式随诊。比较分析两组患者的临床资料及预后差异。结果52例患者均顺利完成手术,发生并发症14例(26.9%)。新辅助化疗组患者术后胰瘘发生率低于单纯血管置换组(0比21.2%),差异有统计学意义(P<0.05)。新辅助化疗组和单纯血管置换组的中位生存时间分别为15个月和13个月,两组患者术后累积生存率差异有统计学意义(P=0.039)。肿瘤糖类抗原(CA)19-9>400 U/ml是影响交界可切除胰腺癌患者术后生存的独立危险因素(RR=4.540,95%CI:2.332~8.836,P<0.001)。结论新辅助化疗可降低交界可切除胰腺癌患者术后胰瘘的发生率,改善患者生存预后。术前较高水平的血清CA19-9是影响交界可切除胰腺癌患者术后生存的独立危险因素。

Objective To evaluate the impact of neoadjuvant chemotherapy on long-term prognosis of patients with borderline resectable pancreatic cancer(BRPC)treated with combined allograft revascularization.Methods The data of patients with BRCP who were treated at Beijing Chaoyang Hospital,Capital Medical University from March 2016 to March 2021 were retrospectively analysed.Of 52 patients who underwent radical surgery combined with allograft revascularization in this study,there were 24 males and 28 females,aged(60.3±10.6)years old.These patients were divided into two groups based on whether they received neoadjuvant chemotherapy before surgery.There were 19 patients in the neoadjuvant chemotherapy group and 33 patients in the vascular replacement group.Outpatient clinic and telephone follow-up were used.The clinical data and prognostic differences between the two groups were then analysed.Results Of 52 patients who underwent surgery successfully,14 patients(26.9%)developed postoperative complications.The incidence of postoperative pancreatic fistula was significantly lower in the neoadjuvant chemotherapy group than the vascular replacement group(0 vs.21.2%,P<0.05).The median survivals were 15 and 13 months in the neoadjuvant chemotherapy and the vascular replacement groups,respectively,with a significant difference in cumulative postoperative survival between the two groups(P=0.039).For patients with BRPC,CA19-9>400 U/ml(RR=4.540,95%CI:2.332-8.836,P<0.001)was an independent risk factor for long-term survival after surgery.Conclusions Neoadjuvant chemotherapy reduced the incidence of postoperative pancreatic fistula and improved survival prognosis in patients with BRPC.A high preoperative serum CA19-9 level was an independent risk factor for long-term survival in patients with BRPC.