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新辅助治疗与T1和T2期胰头癌行胰十二指肠切除术后切缘阳性率较低相关：一项基于国家癌症数据库的分析

Neoadjuvant therapy is associated with lower margin positivity rates after Pancreaticoduodenectomy in T1 and T2 pancreatic head cancers: An analysis of the National Cancer Database.

作者信息

Greco Stephanie H, August David A, Shah Mihir M, Chen Chunxia, Moore Dirk F, Masanam Monika, Turner Amber L, Jabbour Salma K, Javidian Parisa, Grandhi Miral S, Kennedy Timothy J, Alexander H Richard, Carpizo Darren R, Langan Russell C

机构信息

Gastrointestinal and Hepatobiliary Oncology, Rutgers Cancer Institute of New, Jersey.

Department of Surgery, Rutgers Robert Wood Johnson University Medical School.

出版信息

Surg Open Sci. 2020 Dec 16;3:22-28. doi: 10.1016/j.sopen.2020.12.001. eCollection 2021 Jan.

DOI:10.1016/j.sopen.2020.12.001
PMID:33490937
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7807160/
Abstract

BACKGROUND

Neoadjuvant therapy (NAT) for T1/T2 pancreatic adenocarcinoma (PDAC) prior to pancreaticoduodenectomy remains controversial. We compared positive margin rates in patients with clinical T1&T2 tumors who did and did not receive NAT.

METHODS

The National Cancer Database (NCDB) found clinical T1&T2 PDAC patients who underwent pancreaticoduodenectomy from 2004 to 2014. Univariate and multivariate regression determined factors associated with a positive margin and survival.

RESULTS

9795 patients underwent surgery for clinical T1 or T2 pancreatic head adenocarcinoma. 8472 patients had data regarding use of neoadjuvant and adjuvant therapies; of which, 774 (9.1%) received NAT and 435 (5.1%) received both chemotherapy and radiation therapy. NAT was found to lower positive margin rates from 21.8 to 15.5% (p < 0.0001) and when radiation was added this rate dropped to 13.4%. Positive margins were associated with worse overall survival (14.9 vs. 23.9 months; HR 1.702,  < 0.0001).

CONCLUSIONS

NAT is associated with a reduced positive margin rate in patients with T1 and T2 tumors. These findings support ongoing and future clinical trials of NAT in T1 and T2, early stage PDAC to determine impacts on survival.

摘要

背景

胰十二指肠切除术前行新辅助治疗（NAT）用于T1/T2期胰腺腺癌（PDAC）仍存在争议。我们比较了接受和未接受NAT的临床T1和T2期肿瘤患者的切缘阳性率。

方法

国家癌症数据库（NCDB）筛选出2004年至2014年接受胰十二指肠切除术的临床T1和T2期PDAC患者。单因素和多因素回归分析确定与切缘阳性及生存相关的因素。

结果

9795例患者接受了临床T1或T2期胰头腺癌手术。8472例患者有新辅助和辅助治疗使用情况的数据；其中，774例（9.1%）接受了NAT，435例（5.1%）接受了化疗和放疗。发现NAT可将切缘阳性率从21.8%降至15.5%（p＜0.0001），若加用放疗，该率降至13.4%。切缘阳性与较差的总生存期相关（14.9个月对23.9个月；HR 1.702，p＜0.0001）。

结论

NAT与T1和T2期肿瘤患者切缘阳性率降低相关。这些发现支持正在进行的以及未来针对T1和T2期早期PDAC的NAT临床试验，以确定其对生存的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/1a0cfae961ae/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/81e0ea81b27b/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/2b038ca15fac/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/60f6c4284938/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/1a0cfae961ae/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/81e0ea81b27b/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/2b038ca15fac/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/60f6c4284938/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe2/7807160/1a0cfae961ae/gr4.jpg

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