新辅助治疗后胰腺导管腺癌患者总生存的病理反应评估。
Evaluation of Pathologic Response on Overall Survival After Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma.
机构信息
From the Department of Surgery.
Division of Radiation Oncology.
出版信息
Pancreas. 2020 Aug;49(7):897-903. doi: 10.1097/MPA.0000000000001590.
OBJECTIVES
Single-institution studies have shown improved outcomes among patients with a pathologic complete response (pCR) following neoadjuvant therapy. We sought to evaluate the impact of pCR and near-complete response (nCR) on overall survival (OS) using a large national database.
METHODS
The National Cancer Database was queried for patients given a diagnosis of pancreatic cancer from 2004 to 2014. A pCR was defined as no tumor identified in the pancreas after surgical resection. An nCR was defined as a primary tumor less than 1 cm without lymph node metastases. The primary outcome was OS.
RESULTS
A total of 5364 patients underwent neoadjuvant chemotherapy and/or radiation followed by pancreatectomy. Forty-one patients (0.8%) had a pCR, 54 (1%) had an nCR, and the remaining 5266 (98.2%) had an otherwise incomplete response. Patients with pCR had a median OS of 43 months compared with 24 months for nCR and 23 months for incomplete response (P < 0.0001). Only pCR was associated with improved OS on adjusted Cox regression.
CONCLUSIONS
For patients given a diagnosis of pancreatic cancer who underwent neoadjuvant treatment and surgical resection, achieving a pCR was associated with improved OS compared with those with residual tumor. An association between nCR and improved survival was not observed.
目的
单中心研究表明，新辅助治疗后病理完全缓解（pCR）的患者预后得到改善。我们试图利用大型国家数据库评估 pCR 和接近完全缓解（nCR）对总生存（OS）的影响。
方法
从 2004 年至 2014 年，国家癌症数据库中检索出诊断为胰腺癌的患者。pCR 定义为手术切除后胰腺中未发现肿瘤。nCR 定义为原发肿瘤小于 1cm 且无淋巴结转移。主要结局为 OS。
结果
共有 5364 例患者接受了新辅助化疗和/或放疗后行胰腺切除术。41 例（0.8%）患者达到 pCR，54 例（1%）患者达到 nCR，其余 5266 例（98.2%）患者未达到完全缓解。pCR 患者的中位 OS 为 43 个月，而 nCR 为 24 个月，不完全缓解为 23 个月（P<0.0001）。仅 pCR 与调整后的 Cox 回归中 OS 的改善相关。
结论
对于接受新辅助治疗和手术切除的胰腺癌患者，与残留肿瘤相比，达到 pCR 与改善 OS 相关。nCR 与生存改善之间没有关联。
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