Kim Rebecca Y, Christians Kathleen K, Aldakkak Mohammed, Clarke Callisia N, George Ben, Kamgar Mandana, Khan Abdul H, Kulkarni Naveen, Hall William A, Erickson Beth A, Evans Douglas B, Tsai Susan
Department of Surgery, Mary Anne and Charles LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Medicine, Division of Hematology and Oncology, Mary Anne and Charles LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Surg Oncol. 2021 Apr;28(4):2246-2256. doi: 10.1245/s10434-020-09149-3. Epub 2020 Sep 30.
Overall survival (OS) for operable pancreatic cancer (PC) is optimized when 4-6 months of nonsurgical therapy is combined with pancreatectomy. Because surgery renders the delivery of postoperative therapy uncertain, total neoadjuvant therapy (TNT) is gaining popularity.
We performed a retrospective cohort study of patients with operable PC and compared TNT with shorter course neoadjuvant therapy (SNT). Primary outcomes of interest included completion of neoadjuvant therapy (NT) and resection of the primary tumor, receipt of 5 months of nonsurgical therapy, and median OS.
We reviewed 541 consecutive patients from 2009 to 2019 including 226 (42%) with resectable PC and 315 (58%) with borderline resectable (BLR) PC. The median age was 66 years (IQR [59, 72]), and 260 (48%) patients were female. TNT was administered to 89 (16%) patients and SNT was administered to 452 (84%). Both groups were equally likely to complete intended NT and surgery (p = 0.90). Patients who received TNT and surgical resection were more likely to have a complete pathologic response (8% vs 4%, p < 0.01) and were more likely to receive at least 5 months of nonsurgical therapy (67% vs 45%, p < 0.01). The median OS was 26 months [IQR (15, 57)]; not reached among patients treated with TNT, and 25 months [IQR (15, 56)] among patients treated with SNT (p = 0.19).
TNT ensures the delivery of intended systemic therapy prior to a complicated operation without decreasing the chance of successful surgery; a window of operability was not lost. Patients who can tolerate SNT will likely benefit from TNT.
当4 - 6个月的非手术治疗与胰腺切除术相结合时，可手术切除的胰腺癌（PC）的总生存期（OS）可得到优化。由于手术会使术后治疗的实施变得不确定，全新辅助治疗（TNT）越来越受到青睐。
我们对可手术切除的PC患者进行了一项回顾性队列研究，并将TNT与短疗程新辅助治疗（SNT）进行了比较。主要关注的结局包括新辅助治疗（NT）的完成情况和原发肿瘤的切除情况、接受5个月非手术治疗的情况以及中位OS。
我们回顾了2009年至2019年连续的541例患者，其中226例（42%）为可切除的PC，315例（58%）为临界可切除（BLR）PC。中位年龄为66岁（四分位间距[59, 72]），260例（48%）患者为女性。89例（16%）患者接受了TNT，452例（84%）患者接受了SNT。两组完成预期NT和手术的可能性相同（p = 0.90）。接受TNT和手术切除的患者更有可能获得完全病理缓解（8%对4%，p < 0.01），并且更有可能接受至少5个月的非手术治疗（67%对45%，p < 0.01）。中位OS为26个月[四分位间距（15, 57）]；接受TNT治疗的患者未达到，接受SNT治疗的患者为25个月[四分位间距（15, 56）]（p = 0.19）。
TNT可确保在复杂手术前实施预期的全身治疗，而不会降低成功手术的机会；未丧失可手术性窗口。能够耐受SNT的患者可能会从TNT中获益。
