Department of Oncology.
Department of Oncology.
Ann Oncol. 2017 Nov 1;28(11):2786-2792. doi: 10.1093/annonc/mdx495.
Patients with borderline (BL) or locally advanced (LA) pancreatic adenocarcinoma are usually treated with primary chemotherapy (CT), followed by resection when feasible. Scanty data are available about the criteria to candidate patients to resection after CT.
Between 2002 and 2016 overall 223 patients diagnosed with BL or LA pancreatic adenocarcinoma were primarily treated with Gemcitabine combination (4-drugs or nab-paclitaxel-gemcitabine) for 3-6 months followed by surgery and/or chemoradiation. Resection was carried out when radical resection could be predicted by imaging studies and intraoperative findings. The prognostic value of both pre-treatment factors and treatment response was retrospectively evaluated, searching for criteria that could improve the selection of patients for surgery.
Median survival (MS) for the whole population was 18.3 months. Surgical resection was carried out in 61 patients; MS in resected patients was significantly longer (30.0 months) as compared with 162 non-resected patients (16.5 months) (P < 0.00001). According to response criteria, 48% had a radiological partial response, 47% a stable disease and 5% a disease progression); CA19.9 response (reduction >50%) was obtained in 77.8% of patients. Among resected patients, neither pre-treatment factors, including BL/LA distinction, nor radiological response, were able to prognosticate survival differences. Survival of resected patients having no CA19.9 response was significantly lower as compared with responders (MS 15.0 versus 31.5 months, P = 0.04), and was similar to non-responders patients that did not undergo resection (MS 10.9 months, P= 0.25). Multivariate analysis carried out on the overall population, showed that Karnofsky performance status, T3-T4 status, resection and CA19.9 response were independent prognostic factors, while radiological response, BL/LA distinction and baseline CA19.9 had not significant influence on survival.
CA19.9 response may allow a better selection of patients who will benefit from resection after primary CT for BL or LA pancreatic adenocarcinoma.
患有边界性（BL）或局部晚期（LA）胰腺腺癌的患者通常接受初始化疗（CT）治疗，当可行时进行切除。关于 CT 后候选患者进行切除的标准，可用数据很少。
2002 年至 2016 年，共有 223 名诊断为 BL 或 LA 胰腺腺癌的患者接受吉西他滨联合（4 种药物或 nab-紫杉醇-吉西他滨）治疗 3-6 个月，随后进行手术和/或放化疗。当影像学研究和术中发现可以预测根治性切除时，进行切除。回顾性评估了治疗前因素和治疗反应的预后价值，寻找可改善手术患者选择的标准。
全人群的中位生存期（MS）为 18.3 个月。61 例患者接受手术切除；与 162 例未切除患者（16.5 个月）相比，切除患者的 MS 明显更长（30.0 个月）（P<0.00001）。根据反应标准，48%的患者有影像学部分缓解，47%的患者有稳定疾病，5%的患者有疾病进展；77.8%的患者获得 CA19.9 反应（降低>50%）。在接受切除的患者中，包括 BL/LA 区分在内的治疗前因素以及影像学反应均不能预测生存差异。无 CA19.9 反应的切除患者的生存明显低于有反应的患者（MS 15.0 与 31.5 个月，P=0.04），与未行切除的无反应患者相似（MS 10.9 个月，P=0.25）。对全人群进行的多变量分析显示，卡诺夫斯基表现状态、T3-T4 状态、切除和 CA19.9 反应是独立的预后因素，而影像学反应、BL/LA 区分和基线 CA19.9 对生存没有显著影响。
CA19.9 反应可能有助于更好地选择接受 BL 或 LA 胰腺腺癌初始 CT 治疗后行切除的患者。
