新辅助化疗与新辅助放化疗后胰腺腺癌的淋巴结比率及其在术后化疗决策中的应用。
Lymph Node Ratio in Pancreatic Adenocarcinoma After Preoperative Chemotherapy vs. Preoperative Chemoradiation and Its Utility in Decisions About Postoperative Chemotherapy.
机构信息
Division of General Surgery, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA.
出版信息
J Gastrointest Surg. 2019 Jul;23(7):1401-1413. doi: 10.1007/s11605-018-3953-0. Epub 2018 Sep 5.
BACKGROUND
Single-center studies in pancreatic adenocarcinoma have suggested that preoperative chemotherapy (PCT) is associated with higher lymph node ratio (LNR) than preoperative chemoradiation (PCRT). The association of postoperative chemotherapy with overall survival (OS) in patients treated with PCT and PCRT remains unclear. Our objectives were to investigate whether (1) PCT is associated with higher LNR than PCRT and (2) postoperative chemotherapy is associated with longer OS after PCT and PCRT in LNR-stratified cohorts.
METHODS
A retrospective cohort study was performed of patients with pancreatic adenocarcinoma treated with PCT or PCRT followed by resection between 2006 and 2014 in the National Cancer Database. Temporal trends were evaluated with Cuzick's test. OS was evaluated with multivariable Cox regression and inverse probability weighted (IPW) Cox regression.
RESULTS
Of 4187 patients, 1993 (47.6%) received PCT. PCT rates were stable at approximately 30% in 2006-2010 (p = 0.33) but increased to 64.9% by 2014 (p < 0.001). Node positivity rates were higher after PCT than PCRT (62.7 vs. 41.8%, P < 0.001) and mean LNR was higher (0.10 [95% CI 0.096, 0.11] vs. 0.058 [95% CI 0.052, 0.063], P < 0.001). Postoperative chemotherapy was associated with longer OS in patients with LNR 0.01-0.149 after PCT by univariate analysis (median OS 34.5 vs. 26.5 months, P = 0.002), multivariable Cox regression (HR 0.64, 95% CI 0.48, 0.84), and IPW Cox regression (HR 0.72, 95% CI 0.55, 0.94). Postoperative chemotherapy was not associated with longer OS for patients who were node-negative or who had LNR ≥ 0.15 after PCT or for any patient subgroups after PCRT.
CONCLUSIONS
PCT is associated with a higher LNR and higher rates of node positivity than PCRT. Postoperative chemotherapy is associated with longer OS than observation in patients with a LNR of 0.01-0.149 after PCT.
背景
在胰腺腺癌的单中心研究中，术前化疗（PCT）与较高的淋巴结比值（LNR）相关，而术前放化疗（PCRT）则没有。在接受 PCT 和 PCRT 治疗的患者中，术后化疗与总生存期（OS）的关系尚不清楚。我们的目的是调查（1）PCT 是否与较高的 LNR 相关，而 PCRT 则没有，以及（2）在 LNR 分层队列中，术后化疗是否与 PCT 和 PCRT 后的 OS 更长相关。
方法
我们对 2006 年至 2014 年间在国家癌症数据库中接受 PCT 或 PCRT 治疗后行切除术的胰腺腺癌患者进行了回顾性队列研究。采用 Cuzick 检验评估时间趋势。采用多变量 Cox 回归和逆概率加权（IPW）Cox 回归评估 OS。
结果
在 4187 名患者中，有 1993 名（47.6%）接受了 PCT。2006-2010 年，PCT 率稳定在 30%左右（p=0.33），但到 2014 年增加到 64.9%（p<0.001）。与 PCRT 相比，PCT 后阳性淋巴结率更高（62.7%比 41.8%，P<0.001），平均 LNR 更高（0.10[95%CI 0.096,0.11]比 0.058[95%CI 0.052,0.063]，P<0.001）。单因素分析显示，LNR 为 0.01-0.149 的患者接受 PCT 后，术后化疗与较长的 OS 相关（中位 OS 为 34.5 个月比 26.5 个月，P=0.002），多变量 Cox 回归（HR 0.64，95%CI 0.48,0.84）和 IPW Cox 回归（HR 0.72，95%CI 0.55,0.94）。对于淋巴结阴性的患者或 PCT 后 LNR≥0.15 的患者，以及接受任何患者亚组治疗的患者，术后化疗与较长的 OS 无关。
结论
PCT 与较高的 LNR 和较高的阳性淋巴结率相关，而 PCRT 则没有。在接受 PCT 治疗的患者中，LNR 为 0.01-0.149 时，与观察相比，术后化疗与较长的 OS 相关。
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