Cloyd Jordan M, Ejaz Aslam, Shen Chengli, Dillhoff Mary, Williams Terence M, Noonan Anne, Pawlik Timothy M, Tsung Allan
Department of Surgery The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Surgery The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
HPB (Oxford). 2020 Nov;22(11):1569-1576. doi: 10.1016/j.hpb.2020.01.013. Epub 2020 Feb 13.
Neoadjuvant therapy (NT) is increasingly utilized for patients with pancreatic ductal adenocarcinoma (PDAC) but the nationwide incidence and long-term prognosis of a pathologic complete response (pCR) remains poorly understood.
Patients with localized PDAC and known cT and pT stage who received NT prior to pancreatectomy from 2004 to 2016 were identified using the National Cancer Database. The clinicopathologic characteristics and long-term outcomes of patients who did and did not experience a pCR were compared.
Among 7,902 patients who underwent NT prior to pancreatectomy, 244 (3.1%) experienced a pCR while 7,658 (96.9%) did not. On multivariable regression, longer duration of NT (OR 1.20, 95% CI 1.14-1.27 per month) and use of preoperative radiation (OR 9.98, 95% CI 3.05-32.71) were independently associated with a pCR. Median overall survival (OS) was longer among patients who experienced a pCR (77 vs 26 months, p < 0.001). On multivariate analysis, pCR was the strongest predictor of improved OS (HR 0.43, 95%CI 0.32-0.58, p < 0.001).
A pCR following NT for PDAC occurs infrequently but is associated with significantly improved OS. Better predictors of response and more effective preoperative regimens should be aggressively sought.
新辅助治疗（NT）越来越多地应用于胰腺导管腺癌（PDAC）患者，但全国范围内病理完全缓解（pCR）的发生率和长期预后仍知之甚少。
利用国家癌症数据库识别2004年至2016年期间在胰腺切除术前接受NT的局限性PDAC患者以及已知的cT和pT分期。比较发生和未发生pCR的患者的临床病理特征和长期结局。
在7902例胰腺切除术前接受NT的患者中，244例（3.1%）实现了pCR，而7658例（96.9%）未实现。多变量回归分析显示，NT持续时间较长（每月OR 1.20，95%CI 1.14-1.27）和术前放疗的使用（OR 9.98，95%CI 3.05-32.71）与pCR独立相关。实现pCR的患者的中位总生存期（OS）更长（77个月对26个月，p<0.001）。多因素分析显示，pCR是OS改善的最强预测因素（HR 0.43，95%CI 0.32-0.58，p<0.001）。
PDAC患者接受NT后pCR发生率较低，但与OS显著改善相关。应积极寻找更好的反应预测指标和更有效的术前治疗方案。
