Cloyd Jordan M, Chen Hsiang-Chun, Wang Xuemei, Tzeng Ching-Wei D, Kim Michael P, Aloia Thomas A, Vauthey Jean-Nicolas, Lee Jeffrey E, Katz Matthew H G
From the Departments of Surgical Oncology and.
Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX.
Pancreas. 2019 Feb;48(2):216-222. doi: 10.1097/MPA.0000000000001231.
Although the use of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma is increasing, the optimal preoperative treatment regimen remains poorly defined.
All patients with resectable pancreatic ductal adenocarcinoma who received preoperative chemotherapy alone (12%) or chemoradiation therapy (CRT) alone (88%) before pancreatectomy between 1999 and 2014 were included. Propensity score matching with inverse probability weighting was conducted based on age, baseline carbohydrate antigen 19-9, and procedure type.
Patients who received preoperative CRT were more likely to undergo a margin negative (91% vs 79%, P < 0.01) and node negative (53% vs 23%, P < 0.01) resection and experience less locoregional recurrence (LR; 16% vs 33%, P < 0.01) but similar median overall survival (OS; 33.6 vs 26.4 months, P = 0.09). On multivariate analysis, carbohydrate antigen 19-9 (hazard ratio, 1.2; 95% confidence interval [CI], 1.1-1.3) and positive lymph nodes (hazard ratio, 1.5; 95% CI, 1.0-2.2) were associated with OS, whereas tumor size (odds ratio [OR], 1.5; 95% CI, 1.3-1.8), positive lymph nodes (OR, 3.1; 95% CI, 1.8-5.6), and preoperative chemotherapy (OR, 1.8; 95% CI, 1.1-2.9) were associated with LR.
Preoperative CRT is associated with less margin and lymph node positivity, reduced LR, and similar OS compared with preoperative chemotherapy.
尽管新辅助治疗在可切除性胰腺导管腺癌中的应用日益增加，但最佳术前治疗方案仍不明确。
纳入1999年至2014年间所有在胰腺切除术前单独接受术前化疗（12%）或单独接受放化疗（CRT，88%）的可切除性胰腺导管腺癌患者。基于年龄、基线糖类抗原19-9和手术类型进行倾向评分匹配及逆概率加权。
接受术前CRT的患者更有可能进行切缘阴性（91%对79%，P<0.01）和淋巴结阴性（53%对23%，P<0.01）切除，且局部区域复发（LR）较少（16%对33%，P<0.01），但中位总生存期（OS）相似（33.6个月对26.4个月，P = 0.09）。多因素分析显示，糖类抗原19-9（风险比，1.2；95%置信区间[CI]，1.1-1.3）和阳性淋巴结（风险比，1.5；95%CI，1.0-2.2）与OS相关，而肿瘤大小（比值比[OR]，1.5；95%CI，1.3-1.8）、阳性淋巴结（OR，3.1；95%CI，1.8-5.6）和术前化疗（OR，1.8；95%CI，1.1-2.9）与LR相关。
与术前化疗相比，术前CRT与切缘和淋巴结阳性率降低、LR减少及OS相似相关。
