ヒグチ　リヨウタ   HIGUCHI Ryota   樋口　亮太    所属   医学部 医学科（附属八千代医療センター）    職種   講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Evaluation of preoperative prognostic factors in patients with resectable pancreatic ductal adenocarcinoma.
掲載誌名	正式名：Scandinavian journal of gastroenterology 略　 称：Scand J Gastroenterol ISSNコード：15027708/00365521
巻・号・頁	54(6),pp.780-786
著者・共著者	Izumo Wataru, Higuchi Ryota, Furukawa Toru, Yazawa Takehisa, Uemura Shuichirou, Shiihara Masahiro, Yamamoto Masakazu
発行年月	2019/06
概要	Objective: Upfront surgery is the standard treatment for resectable pancreatic ductal adenocarcinomas (R-PDACs); however, these tumors often recur. We investigated the factors governing recurrence and prognosis in patients with R-PDAC. Methods: We analyzed 359 patients who underwent upfront surgery for R-PDAC between 2000 and 2016, and evaluated the relationship between clinicopathological factors and recurrence/outcomes. Results: The rate of recurrence was 74% while the median time to recurrence was 1.2 years. On multivariate analysis, carbohydrate antigen 19-9 (CA19-9) >37 U/mL (hazard ratio [HR]: 2.02), tumor size >2.6 cm (HR: 1.50), pathological grade 3 (HR: 2.58), lymph node metastasis (LNM; HR: 1.65), residual tumor (HR: 1.47) and forgoing adjuvant chemotherapy (HR: 1.31) were risk factors for a shorter recurrence-free survival; the median survival time (MST) was 2.8 years. On multivariate analysis, CA19-9 > 37 U/mL (HR: 1.99), tumor size >2.6 cm (HR: 1.43), pathological grade 3 (HR: 2.93), pathological portal vein invasion (HR: 1.48), LNM (HR: 1.79) and forgoing adjuvant chemotherapy (HR: 1.39) were risk factors for shorter disease-specific survival intervals. When examining outcomes according to preoperatively measurable factors (CA19-9 > 37 U/mL and tumor size >2.6 cm), the median time to recurrence and MSTs of patients with none (n = 83), one (n = 112) and both (n = 164) risk factors were 3.2, 1.8 and 0.8 years; and 7.2, 4.0 and 1.7 years, respectively. Conclusions: CA19-9 > 37 U/mL and tumor size >2.6 cm were preoperative independent risk factors for early recurrence and poor outcomes in patients with R-PDAC. Therefore, preoperative treatment should be considered for such patients.
DOI	10.1080/00365521.2019.1624816
PMID	31180790