Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Surg. 2019 Aug;270(2):340-347. doi: 10.1097/SLA.0000000000002753.
The aim of the study was to identify the survival of patients with locally advanced pancreatic cancer (LAPC) and assess the effect of surgical resection after neoadjuvant therapy on patient outcomes.
An increasing number of LAPC patients who respond favorably to neoadjuvant therapy undergo surgical resection. The impact of surgery on patient survival is largely unknown.
All LAPC patients who presented to the institutional pancreatic multidisciplinary clinic (PMDC) from January 2013 to September 2017 were included in the study. Demographics and clinical data on neoadjuvant treatment and surgical resection were documented. Primary tumor resection rates after neoadjuvant therapy and overall survival (OS) were the primary study endpoints.
A total of 415 LAPC patients were included in the study. Stratification of neoadjuvant therapy in FOLFIRINOX-based, gemcitabine-based, and combination of the two, and subsequent outcome comparison did not demonstrate significant differences in OS of 331 non-resected LAPC patients (P = 0.134). Eighty-four patients underwent resection of the primary tumor (20%), after a median duration of 5 months of neoadjuvant therapy. FOLFIRINOX-based therapy and stereotactic body radiation therapy correlated with increased probability of resection (P = 0.006). Resected patients had better performance status, smaller median tumor size (P = 0.029), and lower median CA19-9 values (P < 0.001) at PMDC. Patients who underwent surgical resection had significant higher median OS compared with those who did not (35.3 vs 16.3 mo, P < 0.001). The difference remained significant when non-resected patients were matched for time of neoadjuvant therapy (19.9 mo, P < 0.001).
Surgical resection of LAPC after neoadjuvant therapy is feasible in a highly selected cohort of patients (20%) and is associated with significantly longer median overall survival.
本研究旨在确定局部晚期胰腺癌（LAPC）患者的生存情况，并评估新辅助治疗后手术切除对患者结局的影响。
越来越多对新辅助治疗反应良好的 LAPC 患者接受了手术切除。手术对患者生存的影响在很大程度上尚不清楚。
本研究纳入了 2013 年 1 月至 2017 年 9 月期间在机构胰腺多学科诊所（PMDC）就诊的所有 LAPC 患者。记录了新辅助治疗和手术切除的人口统计学和临床数据。新辅助治疗后原发肿瘤切除率和总生存期（OS）是主要研究终点。
共纳入 415 例 LAPC 患者。对 FOLFIRINOX 为基础、吉西他滨为基础和两种方案联合的新辅助治疗进行分层，随后对非切除的 331 例 LAPC 患者的 OS 进行比较，差异无统计学意义（P = 0.134）。84 例患者接受了原发肿瘤切除术（20%），新辅助治疗中位时间为 5 个月。FOLFIRINOX 为基础的治疗和立体定向体部放射治疗与增加切除的可能性相关（P = 0.006）。接受手术切除的患者在 PMDC 的表现状态更好，肿瘤中位大小更小（P = 0.029），CA19-9 值更低（P < 0.001）。与未接受手术切除的患者相比，接受手术切除的患者的中位 OS 显著更高（35.3 与 16.3 个月，P < 0.001）。当对新辅助治疗时间进行非切除患者匹配时，差异仍然显著（19.9 个月，P < 0.001）。
在高度选择的患者队列（20%）中，新辅助治疗后对 LAPC 进行手术切除是可行的，与中位总生存期显著延长相关。
