Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD.
The Pancreatic Cancer Precision Medicine Center of Excellence Program, Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Surg. 2021 Jul 1;274(1):162-169. doi: 10.1097/SLA.0000000000003570.
The aim of this study was to characterize the patterns and treatment of disease recurrence in patients achieving a pathological complete response (pCR) following neoadjuvant chemoradiation for advanced pancreatic ductal adenocarcinoma (PDAC).
A pCR is an independent predictor for improved survival in PDAC. However, disease recurrence is still observed in these patients.
Patients with advanced PDAC who were treated with neoadjuvant therapy and had a pCR were identified between 2009 and 2017. Overall survival (OS) was determined from the initiation of neoadjuvant, disease-free survival (DFS) from the date of surgery, and post-recurrence survival (PRS) from the date of recurrence. Factors associated with recurrence were analyzed using a Cox-regression model.
Of 331 patients with borderline resectable or locally advanced PDAC, 30 achieved a pCR following neoadjuvant treatment and pancreatectomy. The median DFS for pCR patients was 29 months and OS 76 months. Recurrence was observed in 14 patients. No clinicopathologic or treatment characteristics were associated with survival. The median PRS following recurrence was 25 months. Treatment following recurrence included chemotherapy, radiation or ablation, and surgical resection. Hepatectomy or completion pancreatectomy was accomplished in 2 patients that remain alive 13 and 62 months, respectively, following metastasectomy.
A pCR following neoadjuvant therapy in patients with advanced PDAC is associated with remarkable survival, although recurrence occurs in about half of patients. Nevertheless, patients with pCR and recurrence respond well to treatment and survival remains encouraging. Advanced molecular characterization and longitudinal liquid biopsy may offer additional assistance with understanding tumor biologic behavior after achieving a pCR.
本研究旨在描述接受新辅助放化疗后达到病理完全缓解（pCR）的晚期胰腺导管腺癌（PDAC）患者疾病复发的模式和治疗方法。
pCR 是 PDAC 患者生存改善的独立预测因素。然而，这些患者仍会出现疾病复发。
在 2009 年至 2017 年间，我们确定了接受新辅助治疗且达到 pCR 的晚期 PDAC 患者。从新辅助治疗开始计算总生存期（OS），从手术日期开始计算无病生存期（DFS），从复发日期开始计算复发后生存期（PRS）。使用 Cox 回归模型分析与复发相关的因素。
在 331 例边界可切除或局部晚期 PDAC 患者中，30 例患者在接受新辅助治疗和胰腺切除术后达到 pCR。pCR 患者的中位 DFS 为 29 个月，OS 为 76 个月。14 例患者出现复发。无临床病理或治疗特征与生存相关。复发后的中位 PRS 为 25 个月。复发后的治疗包括化疗、放疗或消融以及手术切除。肝切除术或完成性胰腺切除术在 2 例转移灶切除后仍存活 13 个月和 62 个月的患者中得以实施。
接受新辅助治疗后达到 pCR 的晚期 PDAC 患者具有显著的生存获益，尽管约一半的患者会出现复发。然而，达到 pCR 并复发的患者对治疗反应良好，生存仍然令人鼓舞。先进的分子特征分析和纵向液体活检可能有助于进一步了解达到 pCR 后肿瘤的生物学行为。
