Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Wolff Center at UPMC, Pittsburgh, PA, USA.
Ann Surg Oncol. 2021 Jul;28(7):3779-3788. doi: 10.1245/s10434-020-09391-9. Epub 2020 Nov 24.
Neoadjuvant therapy is increasingly used for patients with pancreatic ductal adenocarcinoma (PDAC). It is unknown whether neoadjuvant chemoradiotherapy is more effective than chemotherapy (NCRT vs. NAC). We aim to compare pathological and survival outcomes of NCRT and NAC in patients with PDAC.
Single-center analysis of PDAC patients treated with NCRT or NAC followed by resection between December 2008 and December 2018 was performed. Average treatment effect (ATE) was estimated after case-control matching using Mahalanobis distance nearest-neighbor matching. Inverse probability weighted estimates (IPWE)-based ATE was estimated for disease-free survival (DFS) and overall survival (OS).
Among the 418 patients (mean age 66.8 years, 51% female) included in the study, 327 received NAC and 91 received NCRT. NCRT patients had higher rates of locally advanced disease, number of neoadjuvant chemotherapy cycles, more chemotherapy regimen crossover (gemcitabine and 5-FU based), and were more likely to undergo open surgical procedures and/or vascular resection (all p < 0.05). After matched analysis, NCRT was associated with a significant reduction in lymph node positive disease [ATE = (-)0.24, p = 0.007] and lymphovascular invasion [ATE = (-)0.20, p = 0.02]. While NCRT was associated with significantly improved DFS by 9.5 months (p = 0.006), it did not affect OS by IPWE-based ATE after adjusting for adjuvant therapy (ATE = 5.5 months; p = 0.32).
Compared with NAC alone, NCRT is associated with improved pathologic surrogates and disease-free survival, but not overall survival in patients with PDAC.
新辅助治疗越来越多地用于胰腺导管腺癌（PDAC）患者。新辅助化疗和放化疗（NCRT）是否比单纯化疗（NAC）更有效尚不清楚。我们旨在比较 PDAC 患者接受 NCRT 或 NAC 治疗并随后进行切除术的病理和生存结果。
对 2008 年 12 月至 2018 年 12 月期间接受 NCRT 或 NAC 治疗并随后进行切除术的 PDAC 患者进行单中心分析。使用马哈拉诺比斯距离最近邻匹配法进行病例对照匹配后，估计平均治疗效果（ATE）。基于逆概率加权估计（IPWE）的 ATE 用于无病生存（DFS）和总生存（OS）的估计。
在纳入研究的 418 例患者（平均年龄 66.8 岁，51%为女性）中，327 例接受 NAC，91 例接受 NCRT。NCRT 患者局部晚期疾病、新辅助化疗周期数、更多化疗方案交叉（吉西他滨和 5-FU 为基础）的发生率较高，更有可能接受开放手术和/或血管切除术（均 p<0.05）。经过匹配分析后，NCRT 与阳性淋巴结疾病显著减少相关 [ATE=(-)0.24，p=0.007] 和血管淋巴管侵犯 [ATE=(-)0.20，p=0.02]。虽然 NCRT 显著改善了 9.5 个月的 DFS（p=0.006），但在调整辅助治疗后，IPWE 基于 ATE 并未影响 OS（ATE=5.5 个月；p=0.32）。
与单纯 NAC 相比，NCRT 与改善的病理替代物和无病生存相关，但与 PDAC 患者的总生存无关。
