Youngwirth Linda M, Nussbaum Daniel P, Thomas Samantha, Adam Mohamed A, Blazer Dan G, Roman Sanziana A, Sosa Julie A
Duke University Medical Center, Durham, North Carolina.
J Surg Oncol. 2017 Aug;116(2):127-132. doi: 10.1002/jso.24630. Epub 2017 Apr 13.
Neoadjuvant therapy has theoretical benefits for pancreatic cancer; however, its association with perioperative outcomes remains controversial. This study sought to evaluate variation in use of neoadjuvant therapy and outcomes following pancreatic resection.
The National Cancer Data Base (1998-2011) was queried for patients with Stage I or II pancreatic adenocarcinoma who underwent pancreaticoduodenectomy. Subjects were classified by use of neoadjuvant chemotherapy and/or radiation therapy. Factors associated with use of neoadjuvant therapy were evaluated, and outcomes were compared.
A 18 243 patients were identified; 1375 (7.5%) received neoadjuvant therapy. From 1998 to 2011, use of neoadjuvant therapy increased from 4.3% to 17.0%. Patients receiving neoadjuvant therapy were younger (63.1 vs 66.1 years, P = 0.001) and more likely to receive treatment at an academic facility (64.4% vs 51.4%, P < 0.001). Patients who received neoadjuvant therapy were more likely to have negative margins (77.8% vs 85.5%), negative lymph nodes (42.9% vs 59.3%) and tumors confined to the pancreas (65.8% vs 70.6%, all P < 0.001). Patients receiving neoadjuvant therapy had lower 30-day mortality (2.0% vs 4.6%, P < 0.001) and readmission rates (7.4% vs 9.5%, P = 0.02).
Neoadjuvant therapy use is increasing and associated with comparable short-term outcomes. Further studies are needed to identify patients who would benefit from neoadjuvant therapy.
新辅助治疗对胰腺癌具有理论上的益处；然而，其与围手术期结局的关联仍存在争议。本研究旨在评估新辅助治疗的使用差异以及胰腺切除术后的结局。
查询国家癌症数据库（1998 - 2011年）中接受胰十二指肠切除术的I期或II期胰腺腺癌患者。根据新辅助化疗和/或放疗的使用情况对受试者进行分类。评估与新辅助治疗使用相关的因素，并比较结局。
共识别出18243例患者；1375例（7.5%）接受了新辅助治疗。从1998年到2011年，新辅助治疗的使用率从4.3%增至17.0%。接受新辅助治疗的患者更年轻（63.1岁对66.1岁，P = 0.001），且更有可能在学术机构接受治疗（64.4%对51.4%，P < 0.001）。接受新辅助治疗的患者更有可能切缘阴性（77.8%对85.5%）、淋巴结阴性（42.9%对59.3%）以及肿瘤局限于胰腺（65.8%对70.6%，所有P < 0.001）。接受新辅助治疗的患者30天死亡率较低（2.0%对4.6%，P < 0.001），再入院率也较低（7.4%对9.5%，P = 0.02）。
新辅助治疗的使用正在增加，且与相当的短期结局相关。需要进一步研究以确定能从新辅助治疗中获益的患者。
