前瞻性 II 期临床试验验证了新辅助化疗对胰腺腺癌复发模式的影响。

Prospective Phase II Trials Validate the Effect of Neoadjuvant Chemotherapy on Pattern of Recurrence in Pancreatic Adenocarcinoma.

机构信息

Division of Surgical Oncology, Department of Surgery, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

出版信息

Ann Surg. 2022 Nov 1;276(5):e502-e509. doi: 10.1097/SLA.0000000000004585. Epub 2020 Oct 19.

DOI:10.1097/SLA.0000000000004585

PMID:33086310

Abstract

OBJECTIVE

The objective of this study was to characterize the patterns of first recurrence after curative-intent resection for pancreatic adenocarcinoma (PDAC).

SUMMARY OF BACKGROUND DATA

We evaluated the first site of recurrence after neoadjuvant treatment as locoregional (LR) or distant metastasis (DM). To validate our findings, we evaluated the pattern from 2 phase II clinical trials evaluating neoadjuvant chemotherapy (NAC) in PDAC.

METHODS

We identified site of first recurrence from a retrospective cohort of patients from 2011 to 2017 treated with NAC followed by chemoradiation and then an operation or an operation first followed by adjuvant therapy, and 2 separate prospective cohorts of patients derived from 2 phase II clinical trials evaluating patients treated with NAC in borderline-resectable and locally advanced PDAC.

RESULTS

In the retrospective cohorts, 160 out of 285 patients (56.1%) recurred after a median disease-free survival (mDFS) of 17.2 months. The pattern of recurrence was DM in 81.9% of patients, versus LR in 11.1%. This pattern was consistent in patients treated with upfront resection and adjuvant chemotherapy (DM 83.0%, LR 16.9%) regardless of margin-involvement (DM 80.1%, LR 19.4%). The use of NAC did not alter pattern of recurrence; 81.7% had DM and 18.3% had LR. This pattern also remained consistent regardless of margin-involvement (DM 94.1%, LR 5.9%). In the Phase II borderline-resectable trial (NCI# 01591733) cohort of 32 patients, the mDFS was 34.2 months. Pattern of recurrence remained predominantly DM (88.9%) versus LR (11.1%). In the Phase II locally-advanced trial (NCI# 01821729) cohort of 34 patients, the mDFS was 30.7 months. Although there was a higher rate of local recurrence in this cohort, pattern of first recurrence remained predominantly DM (66.6%) versus LR (33.3%) and remained consistent independent of margin-status.

CONCLUSIONS

The pattern of recurrence in PDAC is predominantly DM rather than LR, and is consistent regardless of the use of NAC and margin involvement.

摘要

目的

本研究旨在描述胰腺导管腺癌（PDAC）根治性切除术后首次复发的模式。

背景资料概要

我们评估了新辅助治疗后局部区域（LR）或远处转移（DM）的首次复发部位。为了验证我们的发现，我们评估了两项评估新辅助化疗（NAC）治疗 PDAC 的 II 期临床试验中的模式。

方法

我们从 2011 年至 2017 年接受 NAC 治疗后接受放化疗，然后进行手术或先手术后辅助治疗的回顾性队列中，以及从两项评估 NAC 治疗边界可切除和局部晚期 PDAC 患者的 II 期前瞻性队列中，确定首次复发的部位。

结果

在回顾性队列中，285 例患者中有 160 例（56.1%）在中位无疾病生存期（mDFS）为 17.2 个月后复发。复发模式为 81.9%的患者为 DM，11.1%为 LR。在接受初始手术和辅助化疗的患者中（DM 83.0%，LR 16.9%），无论边缘受累情况如何，这种模式都是一致的（DM 80.1%，LR 19.4%）。NAC 的使用并未改变复发模式；81.7%的患者发生 DM，18.3%的患者发生 LR。无论边缘受累情况如何，这种模式也保持一致（DM 94.1%，LR 5.9%）。在 32 例 NCI#01591733 边界可切除试验队列中，mDFS 为 34.2 个月。复发模式仍主要为 DM（88.9%），LR（11.1%）。在 34 例 NCI#01821729 局部晚期试验队列中，mDFS 为 30.7 个月。虽然该队列中局部复发率较高，但首次复发模式仍主要为 DM（66.6%），LR（33.3%），且与边缘状态无关。