95例胰腺癌R0/R1术后基于放疗的综合治疗患者预后分析

Prognosis analysis of 95 patients treated with radiotherapy-based comprehensive treatment after R0/R1 surgery for pancreatic cancer

背景近年来手术、化疗、放疗以及靶向和免疫等多学科综合治疗的应用明显改善了肿瘤治疗的疗效,但胰腺癌根治性术后患者采用现代综合治疗的疗效尚不明确。目的分析基于放疗的综合治疗在胰腺癌R0/R1术后患者中的临床应用及生存疗效,并探讨术后患者复发转移情况及预后影响因素。方法收集2016年1月-2020年12月在解放军总医院第一医学中心放射治疗科接受放疗的95例R0/R1术后胰腺癌患者临床资料,分析基于放疗的综合治疗在胰腺癌R0/R1术后患者中的临床应用及生存疗效,并探讨其术后复发转移情况及预后影响因素。结果95例患者中位年龄为57(31~75)岁,男:女为59∶36。其中Ⅰ、Ⅱ、Ⅲ期分别为50例、35例、10例。局限性复发、区域性复发、远处转移发生率分别为48.4%(46/95)、30.5%(29/95)、49.5%(47/95)。根据术后治疗手段,单纯放疗组14例,放化疗组81例;根据放疗干预时机,瘤床辅助放疗、局部复发放疗、远处转移放疗分别为11例(11.6%)、57例(60%)、27例(28.4%)。胰腺癌R0/R1术后患者中位无病生存期(median disease-free survival,m DFS)为16.3个月,接受基于放疗的综合治疗患者手术后中位总生存期(median overall survival,m OS)为27.5个月,放疗后m OS为9.9个月,1年、3年、5年生存率分别为93.6%、30.2%、12.4%。多因素分析显示性别、胰周神经侵犯、肿瘤大小、手术与放疗的时间间隔、接受化疗总周期数是患者的独立预后因素(P<0.05)。结论基于放疗的综合治疗可有效改善胰腺癌R0/R1术后患者远期生存。

Background Recently,multidisciplinary comprehensive treatment including surgery,chemotherapy,radiotherapy,targeted therapy,and immunotherapy has made great progress and significantly improved the efficacy of treatment for a variety of tumors.However,the clinical efficacy of modern comprehensive treatment based on radical surgery in patients with pancreatic cancer is still unclear.Objective To analyze the clinical practice and outcome of radiotherapy-based combination therapy in patients with pancreatic cancer after R0/R1 surgery,and explore the postoperative failure pattern and prognostic factors influencing these patients.Methods Totally 95 patients with pancreatic cancer who received radiotherapy after R0/R1 surgery from January 2016 to December 2020 at the Department of Radiation Oncology in the First Medical Center of Chinese PLA General Hospital were collected.The clinical practice and outcome of radiotherapy-based combination therapy in patients with pancreatic cancer after R0/R1 surgery were analyzed,and the postoperative failure pattern and prognostic factors were explored.Results The median age of the 95 patients was 57 years(31-75 years),and the male to female ratio was 59:36.There were 50,35 and 10 patients in stageⅠ,ⅡandⅢ,respectively.Among these patients,14 cases were treated with surgery+radiotherapy,and 81 cases were treated with surgery+radiotherapy+chemotherapy.According to the radiotherapy intervention,11 cases(11.6%)were treated with postoperative adjuvant radiotherapy,57 cases(60%)were treated with radiotherapy for local-regional recurrent lesions,and 27 cases(28.4%)were treated with radiotherapy for distant metastatic lesions.The incidence of localized recurrence,regional recurrence,and distant metastasis was 48.4%(46/95),30.5%(29/95),and 49.5%(47/95),respectively.The median disease-free survival(mDFS)of patients with pancreatic cancer after R0/R1 surgery was 16.3 months,and the median overall survival(mOS)of patients receiving radiation-based comprehensive treatment after R0/R1 surgery and radiotherapy was 27.5 months and 9.9 months,respectively.The corresponding 1-year,3-year,and 5-year survival rates were 93.6%,30.2%,and 12.4%.Multivariate analysis demonstrated that gender,peripancreatic nerve invasion,tumor size,the interval between surgery and radiotherapy,and the number of total cycles of received chemotherapy were independent prognostic factors for these entities(all P<0.05).Conclusion The radiotherapy-based comprehensive treatment can effectively improve the long-term survival of patients with pancreatic cancer after R0/R1 surgery.