Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033-0850, USA; Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, USA.
Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, USA.
Hepatobiliary Pancreat Dis Int. 2021 Feb;20(1):74-79. doi: 10.1016/j.hbpd.2020.08.001. Epub 2020 Aug 17.
Lymph node ratio (LNR) and margin status have prognostic significance in pancreatic cancer. Herein we examined the pathologic and clinical outcomes in patients with borderline resectable pancreatic cancer (BRPC) following neoadjuvant therapy (NAT) and pancreaticoduodenectomy.
Patients who underwent treatment between January 1, 2012 and June 30, 2017 were included. Sequential patients in the BRPC group were compared to a propensity score matched cohort of patients with radiographically resectable pancreatic cancer who underwent upfront surgical resection. The BRPC group was also compared to sequential patients with radiographically resectable pancreatic cancer who required vein resection (VR) during upfront surgery.
There were 50 patients in the BRPC group, 50 patients in the matched control group, and 38 patients in the VR group. Negative margins (R0) were seen in 72%, 64%, and 34% of the BRPC, control, and VR groups, respectively (P = 0.521 for BRPC vs. control; P = 0.002 for BRPC vs. VR), with 24% of the BRPC group requiring a vascular resection. Nodal stage was N0 in 64%, 20%, and 18% of the BRPC, control, and VR groups, respectively (P < 0.001 for BRPC vs. control or VR). When nodal status was stratified into four groups (N0, or LNR ≤ 0.2, 0.2-0.4, ≥ 0.4), the BRPC group had a more favorable distribution (P < 0.001). The median overall survival were 28.8, 38.6, and 19.0 months for the BRPC, control, and VR groups, respectively (log-rank P = 0.096).
NAT in BRPC was associated with more R0 and N0 resections and lower LNR compared to patients undergoing upfront resection for resectable disease.
淋巴结比率（LNR）和切缘状态在胰腺癌中有预后意义。在此，我们研究了接受新辅助治疗（NAT）和胰十二指肠切除术的边界可切除胰腺癌（BRPC）患者的病理和临床结局。
纳入 2012 年 1 月 1 日至 2017 年 6 月 30 日期间接受治疗的患者。BRPC 组中连续的患者与接受直接手术切除的影像学可切除胰腺癌患者的倾向评分匹配队列进行比较。BRPC 组还与直接手术中需要静脉切除（VR）的影像学可切除胰腺癌患者的连续患者进行了比较。
BRPC 组有 50 例患者，匹配对照组有 50 例患者，VR 组有 38 例患者。BRPC、对照组和 VR 组的阴性切缘（R0）分别为 72%、64%和 34%（BRPC 与对照组比较，P=0.521；BRPC 与 VR 比较，P=0.002），BRPC 组中有 24%的患者需要血管切除。BRPC、对照组和 VR 组的淋巴结分期分别为 N0、20%和 18%（BRPC 与对照组或 VR 比较，P<0.001）。当将淋巴结状态分为四组（N0 或 LNR≤0.2、0.2-0.4、≥0.4）时，BRPC 组的分布更有利（P<0.001）。BRPC、对照组和 VR 组的中位总生存期分别为 28.8、38.6 和 19.0 个月（对数秩检验 P=0.096）。
与直接切除可切除疾病的患者相比，BRPC 中接受 NAT 治疗与更多的 R0 和 N0 切除以及更低的 LNR 相关。
