Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan.
Langenbecks Arch Surg. 2020 Aug;405(5):623-633. doi: 10.1007/s00423-020-01914-y. Epub 2020 Jun 27.
This study aimed to reassess the duration of neoadjuvant therapy (NAT) for patients with borderline resectable pancreatic cancer (BRPC).
The medical records of patients with BRPC who received NAT before intended curative resection were retrospectively reviewed. Patient demographics, clinicopathological factors, and prognostic factors for overall survival were analyzed. The serum carbohydrate antigen (CA) 19-9 level was examined monthly during NAT.
A total of 118 patients with BRPC were enrolled. The median survival time and 5-year overall survival were 28.0 months and 31%, respectively. Three months after NAT, the CA19-9 levels were normal in 57% of the patients, and 92% underwent resection. Multivariate analysis showed that radiological partial response (hazard ratio (HR), 0.53; 95% confidence interval (CI), 0.26-0.99; p = 0.047); a normal CA19-9 level after NAT (HR, 0.30; 95% CI, 0.22-0.66; p = 0.006); and tumor resection (HR, 0.29; 95% CI, 0.13-0.67; p = 0.005) were independent predictors of better survival. The median CA19-9 level and the rate of normal CA19-9 levels before and after NAT were 256 (interquartile range (IQR), 23-1197) U/mL and 33%, and 27 (IQR, 7-176) U/mL and 57%, respectively.
A normal CA19-9 level after NAT was an independent predictor of better survival in patients with BRPC. A longer NAT duration might contribute to improved prognosis of patients with elevated CA19-9 levels.
本研究旨在重新评估交界可切除胰腺癌（BRPC）患者新辅助治疗（NAT）的持续时间。
回顾性分析接受意向性根治性切除前接受 NAT 的 BRPC 患者的病历。分析患者的人口统计学、临床病理因素和总生存的预后因素。NAT 期间每月检查血清碳水化合物抗原（CA）19-9 水平。
共纳入 118 例 BRPC 患者。中位生存时间和 5 年总生存率分别为 28.0 个月和 31%。NAT 3 个月后，57%的患者 CA19-9 水平正常，92%的患者接受了手术切除。多因素分析显示，影像学部分缓解（危险比（HR），0.53；95%置信区间（CI），0.26-0.99；p=0.047）；NAT 后 CA19-9 水平正常（HR，0.30；95%CI，0.22-0.66；p=0.006）；以及肿瘤切除（HR，0.29；95%CI，0.13-0.67；p=0.005）是生存更好的独立预测因素。NAT 前后中位 CA19-9 水平和 CA19-9 水平正常率分别为 256（四分位距（IQR），23-1197）U/mL 和 33%，27（IQR，7-176）U/mL 和 57%。
NAT 后 CA19-9 水平正常是 BRPC 患者生存更好的独立预测因素。NAT 持续时间较长可能有助于改善 CA19-9 水平升高患者的预后。
