Kurata Yoshihiro, Shiraki Takayuki, Ichinose Masanori, Kubota Keiichi, Imai Yasuo
Department of Surgery, Chiba University Hospital, Chiba, Japan.
Department of Surgery, Shioya Hospital, International University of Health and Welfare, Tochigi, Japan.
World J Surg Oncol. 2021 Mar 22;19(1):85. doi: 10.1186/s12957-021-02192-8.
Effect of neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC) has remained under investigation. We investigated its effect from a unique perspective and discussed its application.
We retrospecively analyzed consecutive 131 PDAC patients who underwent pancreatoduodenectomy and distal pancreatectomy. Clinicopathologic data at surgery and postoperative prognosis were compared between patients who underwent upfront surgery (UFS) (n = 64) and those who received NAC (n = 67), of which 62 (92.5%) received gemcitabine plus S-1 (GS). The GS regimen resulted in about 15% of partial response and 85% of stable disease in a previous study which analyzed a subset of this study subjects.
Tumor size was marginally smaller, degree of nodal metastasis and rate of distant metastasis were significantly lower, and pathologic stage was significantly lower in the NAC group than in the UFS group. In contrast, significant differences were not observed in histopathologic features such as vessel and perineural invasions and differentiation grade. Notably, disease-free and overall survivals were similar between the two groups adjusted for the pathologic stage, suggesting that effects of NAC, including macroscopically undetectable ones such as control of micro-metastasis and devitalizing tumor cells, may not be remarkable in the majority of PDAC, at least with respect to the GS regimen.
NAC may be useful in downstaging and improving prognosis in a small subset of tumors. However, postoperative prognosis may be determined at the pathologic stage of resected specimen with or without NAC. Therefore, NAC may be applicable to borderline resectable and locally advanced PDAC for enabling surgical resection, but UFS would be desirable for primary resectable PDAC.
新辅助化疗（NAC）对胰腺导管腺癌（PDAC）的疗效仍在研究中。我们从一个独特的角度研究了其疗效并讨论了其应用。
我们回顾性分析了连续131例行胰十二指肠切除术和胰腺远端切除术的PDAC患者。比较了接受 upfront手术（UFS）（n = 64）和接受NAC（n = 67）的患者的手术时临床病理数据和术后预后，其中62例（92.5%）接受吉西他滨加S-1（GS）治疗。在先前一项分析本研究部分受试者的研究中，GS方案导致约15%的部分缓解和85%的病情稳定。
NAC组的肿瘤大小略小，淋巴结转移程度和远处转移率显著较低，病理分期显著低于UFS组。相比之下，在血管和神经周围侵犯以及分化程度等组织病理学特征方面未观察到显著差异。值得注意的是，在根据病理分期进行调整后，两组的无病生存期和总生存期相似，这表明NAC的效果，包括宏观上无法检测到的效果，如对微转移的控制和使肿瘤细胞失活，在大多数PDAC中可能并不显著，至少就GS方案而言是这样。
NAC可能对一小部分肿瘤的降期和改善预后有用。然而，术后预后可能由切除标本的病理分期决定，无论是否接受NAC。因此，NAC可能适用于边界可切除和局部晚期PDAC以实现手术切除，但对于原发性可切除PDAC，UFS可能更可取。
