Faculty of Hepato-Pancreato-Biliary Surgery, First Center, 104607Chinese PLA General Hospital, Beijing, China.
Department of Surgery, 1861Brigham and Women's Hospital, Boston, MA, USA.
Am Surg. 2022 Jun;88(6):1172-1180. doi: 10.1177/0003134821991962. Epub 2021 Jan 31.
Neoadjuvant treatment (NT) has become standard in the management of borderline resectable pancreatic cancer (BR-PDAC), improving prognosis. The primary mechanism for this improvement remains unclear.
Clinicopathological data of patients with BR-PDAC who underwent resection between January 2008 and December 2018 at a single institution were retrospectively reviewed. Univariable and multivariate analyses were used to compare survival between patients who received NT vs. those who underwent upfront resection (UR).
A total of 138 patients were included, 64 underwent UR and 74 NT. Neoadjuvant treatment resulted in higher margin-negative (R0) resection rate (68.9%) than UR (43.8%, = .005). Neoadjuvant treatment was associated with improved overall survival (OS, = .009) and progression-free survival (PFS, = .027). R0 resection was also associated with improved OS ( < .001) and PFS ( < .001). On multivariable analysis, when adjusting for clinically relevant variables without considering R status, NT was an independent predictor for improved OS ( = .046) and PFS ( = .040). When additionally accounting for margin status, R0 was an independent predictor for improved OS ( < .001) and PFS ( < .001), while NT was not. Subgroup analysis, stratified by margin status, revealed that NT was not an independent predictor for OS or PFS for either subgroup.
Neoadjuvant treatment is associated with improved OS and PFS in patients with BR-PDAC; however, this effect is outweighed by margin status. These results suggest that the primary benefit of NT was dependent on facilitating R0 resection. Upfront resection might remain a valid treatment option if R0 resection could be accurately predicted.
新辅助治疗（NT）已成为边界可切除胰腺癌（BR-PDAC）治疗的标准方案，可改善预后。但这种改善的主要机制仍不清楚。
回顾性分析了 2008 年 1 月至 2018 年 12 月期间在单中心接受手术的 BR-PDAC 患者的临床病理数据。采用单变量和多变量分析比较接受 NT 与直接手术（UR）患者的生存情况。
共纳入 138 例患者，其中 64 例行 UR，74 例行 NT。NT 组的阴性切缘（R0）切除率（68.9%）高于 UR 组（43.8%， =.005）。NT 与总生存期（OS， =.009）和无进展生存期（PFS， =.027）的改善相关。R0 切除与 OS（ <.001）和 PFS（ <.001）的改善相关。多变量分析显示，在不考虑 R 状态的情况下，调整临床相关变量后，NT 是 OS（ =.046）和 PFS（ =.040）改善的独立预测因素。当进一步考虑切缘状态时，R0 是 OS（ <.001）和 PFS（ <.001）改善的独立预测因素，而 NT 则不是。分层分析显示，根据切缘状态进行分层，NT 不是 OS 或 PFS 的独立预测因素。
NT 与 BR-PDAC 患者的 OS 和 PFS 改善相关；然而，这种效果被切缘状态所抵消。这些结果表明，NT 的主要获益取决于能否实现 R0 切除。如果能准确预测 R0 切除，UR 可能仍然是一种有效的治疗选择。
