{"title":"基于肿瘤-肠系膜上/门静脉界面分级标准作为胰头导管腺癌患者在新辅助放化疗后行胰十二指肠切除术的生存预后预测因子","authors":"Benson Kaluba, Naohisa Kuriyama, Motonori Nagata, Takahiro Ito, Aoi Hayasaki, Takehiro Fujii, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada, Shugo Mizuno","doi":"10.1002/ags3.70002","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>To assess the ability of a new severity-based tumor-superior mesenteric/portal vein interface criteria to predict survival outcomes in pancreatic ductal adenocarcinoma patients undergoing pancreaticoduodenectomy after neoadjuvant chemoradiotherapy (CRT).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Two hundred and twenty-six post-CRT patients were enrolled and 22 had no tumor-SMV/PV contact, while the remaining 204 had. Based on correlation with overall survival (OS), circumferential (210 degrees) and contact length (25 mm) interface cut-off values were identified, then used to formulate no tumor-SMV/PV contact, non-severe, and severe interface criteria. Significant predictors of disease-free (DFS) and OS were identified.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The severe group had significantly more UR-LA, cStage 3 cases, longer operation times, more intra-operative blood loss, R1 resection, and pPV invasion cases than the no tumor-contact and non-severe interface groups (<i>p</i> < 0.001). Median DFS were 37.7 (no tumor-contact), 17.0 (non-severe), and 5.2 (severe) months and OS was 56.7, 29.9, and 12.0. Among tumor-contact patients, the interface criteria (84.7%) had a better specificity in predicting pPV invasion than tumor-contact length (76.9%) and tumor-circumferential interface (73.8%). Those with pPV invasion had shorter DFS (16.7 vs. 5.7) and OS (28.3 vs. 13.6) than those without pPV invasion. Significant independent predictors of both DFS and OS were the interface criteria, resection margins, and pPV invasion. Clinical and pathological lymph node involvement also influenced DFS, while circumferential interface and pathological tumor stage also impacted OS.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Patients can be stratified as no tumor-contact, non-severe, or severe interface cases and the criteria might be useful in preoperatively predicting not only survival but also intra-operative outcomes and pPV invasion.</p>\n </section>\n </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"842-860"},"PeriodicalIF":2.9000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70002","citationCount":"0","resultStr":"{\"title\":\"A severity-based tumor-superior mesenteric/portal vein interface grading criteria as a predictor of survival outcomes in pancreatic head ductal adenocarcinoma patients undergoing pancreaticoduodenectomy following neoadjuvant chemoradiotherapy\",\"authors\":\"Benson Kaluba, Naohisa Kuriyama, Motonori Nagata, Takahiro Ito, Aoi Hayasaki, Takehiro Fujii, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada, Shugo Mizuno\",\"doi\":\"10.1002/ags3.70002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aim</h3>\\n \\n <p>To assess the ability of a new severity-based tumor-superior mesenteric/portal vein interface criteria to predict survival outcomes in pancreatic ductal adenocarcinoma patients undergoing pancreaticoduodenectomy after neoadjuvant chemoradiotherapy (CRT).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Two hundred and twenty-six post-CRT patients were enrolled and 22 had no tumor-SMV/PV contact, while the remaining 204 had. Based on correlation with overall survival (OS), circumferential (210 degrees) and contact length (25 mm) interface cut-off values were identified, then used to formulate no tumor-SMV/PV contact, non-severe, and severe interface criteria. Significant predictors of disease-free (DFS) and OS were identified.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The severe group had significantly more UR-LA, cStage 3 cases, longer operation times, more intra-operative blood loss, R1 resection, and pPV invasion cases than the no tumor-contact and non-severe interface groups (<i>p</i> < 0.001). Median DFS were 37.7 (no tumor-contact), 17.0 (non-severe), and 5.2 (severe) months and OS was 56.7, 29.9, and 12.0. Among tumor-contact patients, the interface criteria (84.7%) had a better specificity in predicting pPV invasion than tumor-contact length (76.9%) and tumor-circumferential interface (73.8%). Those with pPV invasion had shorter DFS (16.7 vs. 5.7) and OS (28.3 vs. 13.6) than those without pPV invasion. Significant independent predictors of both DFS and OS were the interface criteria, resection margins, and pPV invasion. 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引用次数: 0
摘要
目的评估一种新的基于肿瘤严重程度-肠系膜上/门静脉界面标准预测胰管腺癌患者新辅助放化疗（CRT）后生存结果的能力。方法纳入226例crt后患者，22例无肿瘤- smv /PV接触，其余204例有。基于与总生存期（OS）的相关性，确定了周向（210度）和接触长度（25 mm）界面截止值，然后用于制定无肿瘤- smv /PV接触，非严重和严重的界面标准。确定无病（DFS）和OS的显著预测因子。结果重症组UR-LA、c3期病例、手术时间、术中出血量、R1切除、pPV侵袭病例明显多于无肿瘤接触组和非重症界面组（p < 0.001）。中位DFS分别为37.7个月（无肿瘤接触）、17.0个月（非严重）和5.2个月（严重），OS分别为56.7、29.9和12.0。在肿瘤接触患者中，界面标准（84.7%）预测pPV侵袭的特异性优于肿瘤接触长度（76.9%）和肿瘤周界面（73.8%）。pPV侵袭组的DFS （16.7 vs. 5.7）和OS （28.3 vs. 13.6）均短于无pPV侵袭组。DFS和OS的重要独立预测因子是界面标准、切除边缘和pPV侵袭。临床及病理淋巴结受累程度影响DFS，肿瘤周界面及病理分期影响OS。结论患者可分为无肿瘤接触病例、非严重病例和严重界面病例，术前诊断标准不仅可用于预测患者的生存，还可用于预测术中预后和pPV侵袭情况。
A severity-based tumor-superior mesenteric/portal vein interface grading criteria as a predictor of survival outcomes in pancreatic head ductal adenocarcinoma patients undergoing pancreaticoduodenectomy following neoadjuvant chemoradiotherapy
Aim
To assess the ability of a new severity-based tumor-superior mesenteric/portal vein interface criteria to predict survival outcomes in pancreatic ductal adenocarcinoma patients undergoing pancreaticoduodenectomy after neoadjuvant chemoradiotherapy (CRT).
Methods
Two hundred and twenty-six post-CRT patients were enrolled and 22 had no tumor-SMV/PV contact, while the remaining 204 had. Based on correlation with overall survival (OS), circumferential (210 degrees) and contact length (25 mm) interface cut-off values were identified, then used to formulate no tumor-SMV/PV contact, non-severe, and severe interface criteria. Significant predictors of disease-free (DFS) and OS were identified.
Results
The severe group had significantly more UR-LA, cStage 3 cases, longer operation times, more intra-operative blood loss, R1 resection, and pPV invasion cases than the no tumor-contact and non-severe interface groups (p < 0.001). Median DFS were 37.7 (no tumor-contact), 17.0 (non-severe), and 5.2 (severe) months and OS was 56.7, 29.9, and 12.0. Among tumor-contact patients, the interface criteria (84.7%) had a better specificity in predicting pPV invasion than tumor-contact length (76.9%) and tumor-circumferential interface (73.8%). Those with pPV invasion had shorter DFS (16.7 vs. 5.7) and OS (28.3 vs. 13.6) than those without pPV invasion. Significant independent predictors of both DFS and OS were the interface criteria, resection margins, and pPV invasion. Clinical and pathological lymph node involvement also influenced DFS, while circumferential interface and pathological tumor stage also impacted OS.
Conclusion
Patients can be stratified as no tumor-contact, non-severe, or severe interface cases and the criteria might be useful in preoperatively predicting not only survival but also intra-operative outcomes and pPV invasion.
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