Pancreatic Cancer Program, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Pancreatic Cancer Program, Department of Medicine, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI.
Surgery. 2019 Sep;166(3):277-285. doi: 10.1016/j.surg.2019.05.010. Epub 2019 Jul 2.
It is difficult to successfully deliver multimodality therapy to patients with operable pancreatic cancer. Data on the natural history of such efforts are necessary for physicians to guide shared decision-making with patients and families. We report the survival of consecutive patients with borderline resectable pancreatic cancer who received neoadjuvant therapy before surgery.
Data regarding demographics, neoadjuvant therapy, surgery, pathology, and survival duration were abstracted on consecutive patients with borderline resectable pancreatic cancer diagnosed between 2009 and 2017 and not treated on available clinical trials. Borderline resectable pancreatic cancer was defined based on ≥1 of the following: local tumor anatomy, pretreatment serum carbohydrate antigen 19-9 >2,000 U/mL, and the presence of radiographic lesions indeterminate for metastases.
Neoadjuvant therapy was delivered to 185 patients with borderline resectable pancreatic cancer who were not enrolled in competing clinical trials; 13 (7%) patients received chemoradiation, 12 (7%) received chemotherapy, and 160 (86%) received both. Of the 185 patients, 115 (62%) completed all intended neoadjuvant therapy and surgery; 81 (70%) of 115 underwent pancreaticoduodenectomy; and vascular reconstruction was performed in 51 (44%). A margin negative resection was achieved in 111 (97%) of 115 patients, and 83 (72%) were node negative. Median overall survival for all 185 patients was 20 months; 31 months for the 115 patients who completed all neoadjuvant therapy and surgery as compared to 13 months for the 70 patients who were not resected (P < .0001).
After neoadjuvant therapy, surgical resection was performed in 62% of patients with borderline resectable pancreatic cancer. Those who normalized preoperative serum carbohydrate antigen 19-9 and had node negative pathology achieved the longest survival. To further improve median survival for all patients, we are incorporating adaptive approaches to neoadjuvant therapy sequencing based on objective assessments of response.
对于可手术的胰腺癌患者，成功实施多模式治疗具有一定难度。此类治疗的自然史数据对于医生与患者及家属共同做出决策具有重要指导意义。我们报告了连续接受新辅助治疗后再行手术的边界可切除胰腺癌患者的生存情况。
我们对 2009 年至 2017 年间连续诊断为边界可切除胰腺癌且未参加临床试验的患者进行了新辅助治疗、手术、病理和生存时间的回顾性研究。边界可切除胰腺癌的定义为：存在以下 1 项或多项局部肿瘤解剖学特征、术前血清碳水化合物抗原 19-9 ＞2000 U/ml 和影像学检查显示存在无法确定转移的病变。
185 例未参加竞争性临床试验的边界可切除胰腺癌患者接受了新辅助治疗；其中 13 例（7%）患者接受了放化疗，12 例（7%）患者接受了化疗，160 例（86%）患者同时接受了化疗和放疗。185 例患者中，115 例（62%）完成了所有计划的新辅助治疗和手术；其中 81 例（70%）接受了胰十二指肠切除术，51 例（44%）进行了血管重建。115 例患者中有 111 例（97%）获得了阴性切缘，83 例（72%）患者的淋巴结阴性。185 例患者的中位总生存期为 20 个月；与未接受手术的 70 例患者相比，115 例完成所有新辅助治疗和手术的患者的中位总生存期为 31 个月（P＜0.0001）。
在接受新辅助治疗后，62%的边界可切除胰腺癌患者接受了手术切除。那些术前血清碳水化合物抗原 19-9 正常且淋巴结阴性的患者生存时间最长。为了进一步提高所有患者的中位生存期，我们正在根据客观评估的反应，将新辅助治疗方案的顺序纳入适应性方法。
