Sydney Medical School, The University of Sydney, Sydney, Australia.
School of Medicine, Griffith University, Gold Coast, QLD, Australia; Department of Surgery, QE II Jubilee Hospital, Brisbane, QLD, Australia.
Eur J Surg Oncol. 2021 Oct;47(10):2543-2550. doi: 10.1016/j.ejso.2021.04.005. Epub 2021 Apr 30.
Pancreatic cancer is the 8th commonest cancer and the 5th commonest cause of cancer-related death in Australia, with a 9% average 5-year survival. This study aims to investigate the effects of neoadjuvant treatment on overall survival (OS) and recurrence-free survival (RFS) in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic adenocarcinoma followed by curative resection.
Prospectively-collected demographic, medical, surgical and pathological data of patients with BRPC and LAPC treated with both neoadjuvant therapy (NAT) and surgery at a single tertiary referral centre in Australia were reviewed and analysed.
Between 2012 and 2018, 60 patients, 34 with BRPC and 26 with LAPC, were treated with NAT followed by curative resection. The commonest neoadjuvant chemotherapy regimens were Gemcitabine + Abraxane (51.7%) and FOLFIRINOX (35.0%), with 48.3% of patients additionally receiving neoadjuvant radiotherapy. Median RFS was 30 months and median OS was 35 months. On multivariable analysis, inferior OS was predicted by enlarged loco-regional lymph nodes on initial computed tomography (p = 0.032), larger tumour size post-NAT (p = 0.006) and Common Terminology Criteria for Adverse Events post-NAT toxicity greater than grade 2 (p = 0.015). LAPC patients received more neoadjuvant chemotherapy (p = 0.008) and radiotherapy (p = 0.021) than BRPC and achieved a superior pathological response (p = 0.010).
Patients who respond to NAT likely have a favourable disease biology and will progress well following resection. It is these patients who should be selected for more aggressive upfront management, and those with resistant disease should be spared from high-risk surgery.
在澳大利亚，胰腺癌是第 8 常见的癌症，也是第 5 常见的癌症相关死亡原因，平均 5 年生存率为 9%。本研究旨在探讨新辅助治疗对可切除边界（BRPC）和局部晚期（LAPC）胰腺腺癌患者接受根治性切除术后总生存（OS）和无复发生存（RFS）的影响。
对在澳大利亚一家三级转诊中心接受新辅助治疗（NAT）和手术治疗的 BRPC 和 LAPC 患者的前瞻性收集的人口统计学、医学、手术和病理数据进行了回顾性分析。
2012 年至 2018 年间，共有 60 名患者接受了治疗，其中 34 名患有 BRPC，26 名患有 LAPC，接受了 NAT 联合根治性切除术。最常见的新辅助化疗方案是吉西他滨+白蛋白紫杉醇（51.7%）和 FOLFIRINOX（35.0%），48.3%的患者还接受了新辅助放疗。中位 RFS 为 30 个月，中位 OS 为 35 个月。多变量分析显示，初始 CT 上局部淋巴结肿大（p=0.032）、NAT 后肿瘤大小增大（p=0.006）和 NAT 后不良事件通用术语标准毒性大于 2 级（p=0.015）预测 OS 较差。LAPC 患者接受了更多的新辅助化疗（p=0.008）和放疗（p=0.021），并获得了更好的病理缓解（p=0.010）。
对 NAT 有反应的患者可能具有有利的疾病生物学特性，并且在切除后会很好地进展。这些患者应该被选择接受更积极的初始治疗，而那些具有耐药性的患者应该避免高风险手术。
