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The predictors and patterns of the early recurrence of pancreatic ductal adenocarcinoma after pancreatectomy: the influence of pre- and post- operative adjuvant therapy.
BMC Surgery ( IF 1.9 ) Pub Date : 2019-12-03 , DOI: 10.1186/s12893-019-0644-z
Hironobu Suto 1 , Keiichi Okano 1 , Minoru Oshima 1 , Yasuhisa Ando 1 , Shigeo Takahashi 2 , Toru Shibata 2 , Hideki Kamada 3 , Hideki Kobara 3 , Tsutomu Masaki 3 , Yasuyuki Suzuki 1
Affiliation  

BACKGROUND The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma recurrence are unclear. This study attempted to identify the predictive factors for early pancreatic ductal adenocarcinoma recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. METHODS One hundred and fifteen patients undergoing curative resection for pancreatic ductal adenocarcinoma between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did (n = 34) and did not (n = 81) experience a recurrence within 6 months postoperatively. RESULTS Multivariate analyses demonstrated postoperative CA19-9 de-normalization, no postoperative adjuvant chemotherapy, and serosal invasion were independent risk factors for early recurrence (P < 0.001, P = 0.001, and P = 0.010, respectively). A subgroup analysis showed patients with (n = 51) and without (n = 64) preoperative chemoradiotherapy had different predictors. Although postoperative adjuvant chemotherapy was not a significant indicator in patients with preoperative chemoradiotherapy, CA19-9 de-normalization and no postoperative adjuvant chemotherapy were significant indicators in patients without preoperative chemotherapy. Preoperative chemotherapy strongly prevented early local recurrence while postoperative adjuvant chemotherapy prevented early distant recurrence. CONCLUSIONS CA19-9 de-normalization was an important predictor of early recurrence of pancreatic ductal adenocarcinoma. Although postoperative adjuvant chemotherapy was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative chemoradiotherapy could strongly prevent the early local recurrence of pancreatic ductal adenocarcinoma. These perioperative adjuvant therapies could have a complementary relationship.

中文翻译:

胰腺切除术后胰腺导管腺癌早期复发的预测因素和模式:术前和术后辅助治疗的影响。

背景技术尚不清楚预测或影响早期胰腺导管腺癌复发的围手术期因素。这项研究试图确定胰腺切除术后早期胰腺导管腺癌复发的预测因素以及术前和术后辅助治疗的影响。方法回顾性分析我院2000年至2016年间收治的115例胰腺导管腺癌患者。将患者分为两组:在术后6个月内复发(n = 34)和未复发(n = 81)的患者。结果多因素分析表明,术后CA19-9正常化,术后无辅助化疗,浆膜浸润是早期复发的独立危险因素(P <0.001,P = 0。001,且P分别为0.010)。亚组分析显示,术前放化疗的患者(n = 51)和不进行术前(n = 64)的预测指标不同。尽管术前放化疗的患者术后辅助化疗不是显着指标,但术前无放化疗的患者CA19-9异常正常化和术后无辅助化疗是显着指标。术前化疗强烈地预防了早期局部复发,而术后辅助化疗则预防了早期远处复发。结论CA19-9去正常化是胰腺导管腺癌早期复发的重要预测指标。尽管术后辅助化疗是预防早期复发(尤其是远距离复发)的重要预防措施,术前放化疗可以强烈地预防胰腺导管腺癌的早期局部复发。这些围手术期辅助治疗可能具有互补关系。
更新日期:2019-12-03
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