Department of Surgery, Policlinico GB Rossi, University of Verona, Italy.
Am J Surg. 2012 Feb;203(2):132-9. doi: 10.1016/j.amjsurg.2011.03.008. Epub 2011 Aug 6.
Neoadjuvant treatment frequently is performed in unresectable/borderline resectable pancreatic cancer. The aim of this study was to retrospectively compare postoperative outcomes and survival of patients who underwent pancreatectomy after neoadjuvant treatment for locally advanced/borderline resectable pancreatic cancer (neoadjuvant treatment group) with those of patients with resectable disease who underwent upfront surgery.
Between 2000 and 2008, there were 403 patients who underwent pancreatic cancer resection, 41 (10.1%) patients after neoadjuvant treatment for initially unresectable tumors and 362 (89.9%) patients had upfront surgery. Univariate and multivariable analyses were performed.
Mortality/morbidity rates were similar in the 2 groups. Nodal metastases were significantly lower in the neoadjuvant treatment group (31.7% vs 86.2%; P < .001). A complete pathologic response was observed in 13.6% after neoadjuvant treatment. Median disease-specific survival from resection was 35 and 27 months in the neoadjuvant treatment and upfront groups, respectively (P = .74). In the neoadjuvant treatment group survival rates were similar in N0/N1 patients.
Postoperative mortality and morbidity do not significantly increase after neoadjuvant treatment. Neoadjuvant treatment in locally advanced pancreatic cancer can lead to an objective pathologic response, but this does not significantly improve survival after resection.
新辅助治疗常应用于不可切除/边界可切除的胰腺癌。本研究旨在回顾性比较局部晚期/边界可切除胰腺癌患者行新辅助治疗后行胰腺切除术（新辅助治疗组）与直接行手术治疗（可切除疾病组）的术后结果和生存情况。
2000 年至 2008 年间，共有 403 例胰腺癌患者接受了胰腺切除术，其中 41 例（10.1%）患者在最初不可切除的肿瘤行新辅助治疗后手术，362 例（89.9%）患者直接行手术。进行了单因素和多因素分析。
两组死亡率/发病率相似。新辅助治疗组的淋巴结转移明显较低（31.7%比 86.2%；P<.001）。新辅助治疗后观察到完全病理缓解的比例为 13.6%。从切除开始，新辅助治疗组和直接手术组的中位疾病特异性生存率分别为 35 个月和 27 个月（P=.74）。在新辅助治疗组，N0/N1 患者的生存率相似。
新辅助治疗后术后死亡率和发病率无明显增加。局部晚期胰腺癌的新辅助治疗可导致客观的病理缓解，但这并不能显著改善切除后的生存。
