- 作者：Takumi Miura ; Satoshi Hirano ; Toru Nakamura ; Eiichi Tanaka ; Toshiaki Shichinohe ; Takahiro Tsuchikawa ; Kentaro Kato ; Joe Matsumoto ; Satoshi Kondo
- 刊名：Surgery
- 出版年：March, 2014
- 年：2014
- 卷：155
- 期：3
- 页码：457-467
- 全文大小：351 K
Background
Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) provides good local control for locally advanced pancreatic body cancer, but early recurrence still occurs. In this study, we aimed to establish a new scoring system to predict prognosis using preoperative factors in patients with locally advanced pancreatic body cancer who undergo DP-CAR.Methods
Prognostic factors were analyzed using various data collected retrospectively from 50 consecutive patients who underwent DP-CAR. Using these preoperative factors, a scoring system to predict prognosis was established.
Results
Multivariate analysis identified intraoperative blood loss (鈮?40聽mL; hazard ratio [HR], 25.179; P聽=聽.0003), preoperative platelet counts (<150聽脳聽109/L; HR, 7.433; P聽=聽.0043), preoperative C-reactive protein (CRP) levels (鈮?.4聽mg/dL; HR, 7.064; P聽=聽.0018), and preoperative carbohydrate antigen 19-9 (CA19-9) levels (鈮?00 U/mL; HR, 8.197; P聽=聽.0053) as independent adverse prognostic factors. For the 3 preoperative factors, preoperative platelet counts <150聽脳聽109/L, preoperative CRP levels 鈮?.4聽mg/dL, and preoperative CA19-9 levels 鈮?00 U/mL were allocated 1 point each. The total score was defined as the Preoperative Prognostic Score (PPS). The estimated disease-specific 1- and 5-year survival rates for the 26 patients with PPS0 were 95.7%, and 49.1%, respectively, and for the 15 patients with PPS1, they were 86.7% and not available, respectively. The median survival times for PPS0 and PPS1 were 50.6 and 22.3聽months, respectively. In contrast, in the 9 patients with PPS2/3, 1- and 5-year survival rates were 33.3% and 0%, respectively, and median survival time was only 7.7聽months.
Conclusion
A new prognostic scoring system using the preoperative platelet count, CRP, and CA19-9 enables preoperative prediction of prognosis and facilitates selection of appropriate treatment for borderline resectable cases of locally advanced pancreatic body cancer.