Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Ann Surg Oncol. 2011 Dec;18(13):3601-7. doi: 10.1245/s10434-011-2086-4. Epub 2011 Sep 27.
Pathologic response to preoperative therapy is increasingly recognized as an important prognostic factor in solid tumors. The impact of pathologic response on survival in pancreatic adenocarcinoma is not well established.
Data on 135 consecutive patients treated with chemoradiation followed by pancreatectomy for adenocarcinoma of the pancreatic head and/or body between July 1987 and May 2009 were reviewed. Histopathologic examination was performed in 107 patients to determine pathologic response, defined as minor (<50% fibrosis relative to residual neoplastic cells), partial (50-94% fibrosis), or major (95-100% fibrosis).
Minor, partial, and major pathologic response rates were 17% (n = 18), 64% (n = 68), and 19% (n = 21), including a 7% (n = 8) complete pathologic response rate. Pathologic response correlated with R0 resection (P = 0.019), negative lymph nodes (P = 0.006), and smaller tumor size (P = 0.001). Median survival rates by pathologic response were as follows: 17 months [95% confidence interval (CI), 0-36 months] for minor response, 20 months (95% CI, 17-23 months) for partial response, and 66 months (95% CI, 8-124 months) for major response (minor versus partial response, P = not significant; partial versus major response, P < 0.001). On multivariate analysis, major pathologic response was the only factor significantly associated with improved survival (P = 0.025; hazard ratio, 2.26).
Major pathologic response to preoperative therapy occurs in a minority of patients with pancreatic adenocarcinoma and is independently associated with prolonged survival.
术前治疗的病理反应越来越被认为是实体瘤的一个重要预后因素。病理反应对胰腺腺癌生存的影响尚未得到很好的确定。
回顾了 1987 年 7 月至 2009 年 5 月期间 135 例连续接受化疗和放疗后行胰头和/或体部腺癌切除术的患者的数据。对 107 例患者进行了组织病理学检查，以确定病理反应，定义为轻度（相对于残留肿瘤细胞纤维化<50%）、部分（50-94%纤维化）或主要（95-100%纤维化）。
轻度、部分和主要病理反应率分别为 17%（n=18）、64%（n=68）和 19%（n=21），包括 7%（n=8）的完全病理反应率。病理反应与 R0 切除（P=0.019）、阴性淋巴结（P=0.006）和肿瘤体积较小（P=0.001）相关。根据病理反应的中位生存时间如下：轻度反应为 17 个月（95%置信区间，0-36 个月），部分反应为 20 个月（95%置信区间，17-23 个月），主要反应为 66 个月（95%置信区间，8-124 个月）（轻度与部分反应，P=无显著性差异；部分与主要反应，P<0.001）。多变量分析显示，主要的病理反应是唯一与生存改善显著相关的因素（P=0.025；危险比，2.26）。
术前治疗的主要病理反应在少数胰腺腺癌患者中发生，与生存时间延长独立相关。
