交界性和局部晚期胰腺腺癌术前治疗后病理完全缓解患者的特征及预后：一项AGEO多中心回顾性队列研究
Characteristic and outcomes of patients with pathologic complete response after preoperative treatment in borderline and locally advanced pancreatic adenocarcinoma: An AGEO multicentric retrospective cohort.
作者信息
Kourie Hampig, Auclin Edouard, Cunha Antonio Sa, Gaujoux Sebastien, Bruzzi Mathieu, Sauvanet Alain, Lourenco Nelson, Trouilloud Isabelle, Louafi Samy, El-Hajjar Ahmad, Vaillant Jean Christophe, Smith Denis, Touchefeu Yann, Bachet Jean-Baptiste, Pietrasz Daniel, Taieb Julien
机构信息
Sorbonne Paris-Cité, Paris Descartes University, hepatogastroenterology and gastrointestinal oncology department, hôpital Européen Georges-Pompidou, 75015 Paris, France; Unité de génétique médicale, faculté de médecine, université Saint Joseph de Beyrouth, Beyrouth, Lebanon.
Unité de génétique médicale, faculté de médecine, université Saint Joseph de Beyrouth, Beyrouth, Lebanon; Methodology and quality of life unit in oncology, university hospital of Besançon, Besançon, France; Université Bourgogne Franche-Comté, Inserm, EFS BFC, UMR1098, interactions Hôte-Greffon-tumeur/ingenierie cellulaire et génique, 25000 Besançon, France.
出版信息
Clin Res Hepatol Gastroenterol. 2019 Nov;43(6):663-668. doi: 10.1016/j.clinre.2019.03.007. Epub 2019 Apr 24.
INTRODUCTION
Following publication of improved patients' outcome using first line FOLFIRINOX for metastatic pancreatic adenocarcinoma, many physicians now prescribe it as neo-adjuvant or induction treatment for borderline and locally advanced pancreatic cancer. A pathologic complete response, rarely seen with previous preoperative regimens, is sometimes observed in these patients. The aim of this study was to assess long-term outcomes of patients presenting pathologic complete response after preoperative FOLFIRINOX usually followed by chemo-radiation therapy for non-metastatic pancreatic adenocarcinoma.
MATERIAL AND METHODS
We retrospectively identified all resected patients with pancreatic cancer presenting pathologic complete response after FOLFIRINOX in 9 French centers from the AGEO group between November 2010 and May 2017.
RESULTS
29 patients were enrolled, 14 had borderline, 14 locally advanced and 1 oligo-metastatic pancreatic cancer. M/F ratio was 1.2 and the mean age was 57 years. All patients were treated with FOLFIRINOX (n = 29), de-escalated to gemcitabine (n = 1) and FOLFIRI (n = 2), and 24 (83 %) received radiation therapy after chemotherapy. Objective response rate to preoperative chemotherapy was 66% (RECIST V1.1). Only 8 patients received postoperative chemotherapy. After a median follow-up of 34 months from surgery, the median overall survival was not reached and the median disease free survival was 48 months. The 1-year and 2-year survival rates were 100% for OS and 96% and 72 % for DFS from surgery, 8 of the 9 observed recurrences were distant metastases.
CONCLUSIONS
The promising 1 and 2-year overall survival and disease free survival rates suggest that pathologic complete response is a major prognostic factor in resected pancreatic cancer following preoperative chemo-radiotherapy. A longer follow-up and prospective series are now necessary to confirm these encouraging results and to potentially validate pathologic complete response as a relevant surrogate marker of preoperative treatment efficacy.
引言
在一线使用FOLFIRINOX方案治疗转移性胰腺腺癌取得改善患者预后的结果发表后，许多医生现在将其作为交界性和局部晚期胰腺癌的新辅助或诱导治疗方案。这些患者有时会出现病理完全缓解，这在既往术前治疗方案中很少见。本研究的目的是评估术前接受FOLFIRINOX治疗后出现病理完全缓解、通常随后接受化疗放疗的非转移性胰腺腺癌患者的长期预后。
材料与方法
我们回顾性分析了2010年11月至2017年5月期间法国AGEO组9个中心所有接受FOLFIRINOX治疗后出现病理完全缓解的胰腺癌切除患者。
结果
共纳入29例患者，其中14例为交界性胰腺癌，14例为局部晚期胰腺癌，1例为寡转移性胰腺癌。男女比例为1.2，平均年龄为57岁。所有患者均接受FOLFIRINOX治疗（n = 29），1例降级为吉西他滨治疗，2例改为FOLFIRI治疗，24例（83%）在化疗后接受了放疗。术前化疗的客观缓解率为66%（RECIST V1.1标准）。仅8例患者接受了术后化疗。术后中位随访34个月，总生存期未达到中位值，无病生存期为48个月。从手术开始计算，1年和2年总生存率均为100%，无病生存率分别为96%和72%，观察到的9例复发中有8例为远处转移。
结论
令人鼓舞的1年和2年总生存率及无病生存率表明，病理完全缓解是术前放化疗后切除的胰腺癌的主要预后因素。现在需要更长时间的随访和前瞻性研究系列来证实这些令人鼓舞的结果，并有可能验证病理完全缓解作为术前治疗疗效的相关替代标志物。
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