Sho Masayuki, Akahori Takahiro, Tanaka Toshihiro, Kinoshita Shoichi, Nagai Minako, Tamamoto Tetsuro, Ohbayashi Chiho, Hasegawa Masatoshi, Kichikawa Kimihiko, Nakajima Yoshiyuki
Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
Department of Radiology, Nara Medical University, Kashihara, Nara, Japan.
J Hepatobiliary Pancreat Sci. 2015 Jul;22(7):563-70. doi: 10.1002/jhbp.258. Epub 2015 Apr 29.
Much attention has been paid to neoadjuvant treatment (NAT) as a new strategy especially for borderline resectable pancreatic cancer (BRPC). However, the optimal indication of NAT remains undetermined.
We analyzed 248 patients with pancreatic cancer (PC). One hundred resectable tumors were classified as R group. Sixty-nine tumors with venous involvement were classified as BR-P group, while 31 tumors with arterial involvement were classified as BR-A group. Ninety-nine patients received NAT. Furthermore, 48 unresectable locally advanced PC served as controls (LAPC group). Among them, 11 patients received adjuvant surgery afterwards (Ad-surg group).
The overall median survival time in the R, BR-P and BR-A groups was 45.3, 24.8 and 16.8 months. In the R and BR-P groups, patients treated with NAT had a better prognosis than those without. In contrast, NAT had no impact on prognosis in the BR-A group. Patients treated with NAT in the BR-P, but not BR-A group, had a better prognosis than patients in the LAPC group. Furthermore, patients in the Ad-surg group had a significantly better prognosis than patients in the BR-A group.
Borderline resectable pancreatic cancer with venous involvement, but without arterial involvement, may be a good indication for NAT. Our data highlight the importance of preoperative resectability assessment to evaluate the indication and efficacy of NAT.
新辅助治疗(NAT)作为一种新策略,尤其是对于可切除边缘的胰腺癌(BRPC),已受到广泛关注。然而,NAT的最佳适应证仍未确定。
我们分析了248例胰腺癌(PC)患者。100例可切除肿瘤被归类为R组。69例有静脉侵犯的肿瘤被归类为BR-P组,而31例有动脉侵犯的肿瘤被归类为BR-A组。99例患者接受了NAT。此外,48例不可切除的局部晚期PC患者作为对照(LAPC组)。其中,11例患者随后接受了辅助手术(Ad-surg组)。
R、BR-P和BR-A组的总体中位生存时间分别为45.3、24.8和16.8个月。在R组和BR-P组中,接受NAT治疗的患者预后优于未接受治疗的患者。相比之下,NAT对BR-A组的预后没有影响。BR-P组而非BR-A组中接受NAT治疗的患者预后优于LAPC组患者。此外,Ad-surg组患者的预后明显优于BR-A组患者。
有静脉侵犯但无动脉侵犯 的可切除边缘胰腺癌可能是NAT的良好适应证。我们的数据强调了术前可切除性评估对评估NAT适应证和疗效的重要性。