胰腺腺癌切除术后的常规成像或症状随访。

IF 15.7 1区 医学 Q1 SURGERY
Paul C M Andel, Iris W J M van Goor, Simone Augustinus, Frederik Berrevoet, Marc G Besselink, Rajesh Bhojwani, Ugo Boggi, Stefan A W Bouwense, Geert A Cirkel, Jacob L van Dam, Angela Djanani, Dimitri Dorcaratto, Stephan Dreyer, Marcel den Dulk, Isabella Frigerio, Poya Ghorbani, Mara R Goetz, Bas Groot Koerkamp, Filip Gryspeerdt, Camila Hidalgo Salinas, Martijn Intven, Jakob R Izbicki, Rosa Jorba Martin, Emanuele F Kauffmann, Reinhold Klug, Mike S L Liem, Misha D P Luyer, Manuel Maglione, Elena Martin-Perez, Mark Meerdink, Vincent E de Meijer, Vincent B Nieuwenhuijs, Andrej Nikov, Vitor Nunes, Elizabeth Pando Rau, Dejan Radenkovic, Geert Roeyen, Francisco Sanchez-Bueno, Alejandro Serrablo, Ernesto Sparrelid, Konstantinos Tepetes, Rohan G Thakkar, George N Tzimas, Robert C Verdonk, Meike Ten Winkel, Alessandro Zerbi, Vincent P Groot, I Quintus Molenaar, Lois A Daamen, Hjalmar C van Santvoort
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引用次数: 0

摘要

重要性:国际指南对胰腺导管腺癌(PDAC)胰腺切除术后随访的常规成像建议缺乏一致性。因此,全球不同中心的随访策略也不尽相同:目的:比较欧洲-非洲肝胰胆协会(E-AHPBA)下属国际中心胰腺切除术后接受无症状随访或常规影像学检查的 PDAC 复发患者的临床结果,包括以复发为重点的治疗和生存率:这是一项前瞻性国际横断面研究。2020年至2021年期间,共有来自13个国家的33个E-AHPBA中心的患者参与了研究。根据预先确定的研究方案,前瞻性纳入了接受PDAC切除术并确诊为疾病复发的患者。根据术后随访策略对患者进行分层:无症状随访(即无常规影像学检查)或常规影像学检查:主要结果和测量指标:用卡普兰-梅耶曲线估算总生存期(OS),并用对数秩检验进行比较。为调整潜在的混杂因素,采用多变量逻辑回归评估随访策略与复发重点治疗之间的关系。多变量 Cox 比例危险分析用于研究随访策略与 OS 之间的独立关联:共纳入 333 例 PDAC 复发患者(平均 [SD] 年龄 65 [11] 岁;184 例男性 [55%])。最后一名患者入组 2 年后进行分析时的随访中位数(IQR)为 40 (30-58) 个月。在所有患者中,98 名患者(29%)接受了症状随访,235 名患者(71%)接受了常规影像学检查。接受症状随访组和常规成像组的OS分别为23个月(95% CI,19-29个月)和28个月(95% CI,24-30个月)(P = .01)。常规成像与接受以复发为重点的治疗(调整后的几率比为2.57;95% CI为1.22-5.41;P = .01)和延长OS(调整后的危险比为0.75;95% CI为0.56-.99;P = .04)有关:在这项国际性前瞻性横断面研究中,PDAC胰腺切除术后常规随访成像与接受以复发为重点的治疗和延长OS有独立关联。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma.

Importance: International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide.

Objective: To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).

Design, setting, and participants: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging.

Exposures: Symptomatic follow-up or routine imaging in patients who underwent PDAC resection.

Main outcomes and measures: Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS.

Results: Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04).

Conclusion and relevance: In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

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来源期刊
JAMA surgery
JAMA surgery SURGERY-
CiteScore
20.80
自引率
3.60%
发文量
400
期刊介绍: JAMA Surgery, an international peer-reviewed journal established in 1920, is the official publication of the Association of VA Surgeons, the Pacific Coast Surgical Association, and the Surgical Outcomes Club.It is a proud member of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications.
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