Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Surg Oncol. 2021 Jan;123(1):245-251. doi: 10.1002/jso.26267. Epub 2020 Oct 25.
There are limited data on the efficacy of neoadjuvant therapy (NAT) for early-stage distal pancreas adenocarcinoma (PDAC). Previous studies focused on adenocarcinoma of the head of the pancreas or dealt with borderline and locally advanced tumors of the body and tail.
This is a retrospective study of the National Cancer Database between 2006 and 2015. A propensity-matched analysis was performed to compare overall survival estimates between NAT and upfront resection (UR) groups.
A total of 5003 distal pancreatectomies for PDAC were identified, of whom 408 (9%) received NAT. After 1:1 matching, 353 NAT patients were compared with 353 UR patients. NAT was associated with lower 90-day mortality. There were no differences in the number of lymph nodes retrieved, or length of stay. With matching, the NAT group had higher median overall survival compared with UR (33.0 vs. 27.0 months; p = 0.009) and adjusted overall survival (hazard ratio = 0.63, 95% confidence interval = 0.51-0.77; p < 0.001).
The receipt of NAT followed by distal pancreatectomy for early-stage distal PDAC is associated with improved overall survival compared with UR. This study supports the use of NAT in the multimodal therapy paradigm of early-stage adenocarcinoma of the body and tail of the pancreas.
早期远端胰腺腺癌（PDAC）的新辅助治疗（NAT）疗效数据有限。既往研究主要集中在胰头腺癌或处理交界性和局部进展期胰体尾部肿瘤。
这是一项 2006 年至 2015 年国家癌症数据库的回顾性研究。采用倾向评分匹配分析比较 NAT 组与 upfront resection（UR）组的总生存率。
共确定了 5003 例 PDAC 远端胰腺切除术，其中 408 例（9%）接受了 NAT。1:1 匹配后，将 353 例 NAT 患者与 353 例 UR 患者进行比较。NAT 与 90 天死亡率降低相关。两组淋巴结检出数或住院时间无差异。匹配后，NAT 组的中位总生存期优于 UR（33.0 与 27.0 个月；p=0.009）和调整后的总生存期（危险比=0.63，95%置信区间=0.51-0.77；p<0.001）。
与 UR 相比，早期远端 PDAC 行 NAT 后行远端胰腺切除术与改善的总生存率相关。本研究支持将 NAT 用于胰体尾部早期腺癌的多模式治疗模式。
