胰腺癌伴腹膜转移患者的转化手术
Conversion surgery in patients with pancreatic cancer and peritoneal metastasis.
作者信息
Yamada Suguru, Fujii Tsutomu, Yamamoto Tomohisa, Takami Hideki, Yoshioka Isaku, Yamaki So, Sonohara Fuminori, Shibuya Kazuto, Motoi Fuyuhiko, Hirano Satoshi, Murakami Yoshiak, Inoue Hitoshi, Hayashi Masamichi, Hashimoto Daisuke, Murotani Kenta, Kitayama Joji, Ishikawa Hideki, Kodera Yasuhiro, Sekimoto Mitsugu, Satoi Sohei
机构信息
Nagoya University Graduate School of Medicine, Gastroenterological Surgery, Nagoya, Japan.
Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan.
出版信息
J Gastrointest Oncol. 2021 Apr;12(Suppl 1):S110-S117. doi: 10.21037/jgo-20-243.
BACKGROUND
Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal malignancies globally. We have previously explored the clinical efficacy of intraperitoneal (IP) paclitaxel therapy for patients with PDAC and peritoneal metastasis, which demonstrated favourable response and disease control rates. However, the real implications of conversion surgery after IP therapy remain unclear.
METHODS
We conducted two multicenter clinical trials of IP therapy with paclitaxel in patients with PDAC and peritoneal metastasis. We focused on patients who underwent conversion surgery and investigated the long-term outcomes, particularly, initial recurrence patterns and long-term survival.
RESULTS
Seventy-nine patients with PDAC and peritoneal metastasis were treated, and 33 (41.8%) patients received SP (intravenous IP paclitaxel with S-1) and 46 (58.3%) were administered GAP (intravenous gemcitabine + nab-paclitaxel combined with IP paclitaxel) combination therapy. Of the 79 patients, 16 (20.3%) underwent conversion surgery. The median time to surgery was 9.0 (range, 4.1-13.0) months after the initiation of chemotherapy. Finally, 13 (81.3%) patients underwent R0 resection. Evans grade was IIA in nine patients, IIB in four patients, III in two patients, and IV in one patient. The median overall survival time in patients who underwent conversion surgery was 32.5 (range, 13.5-66.9) months. Twelve (75.0%) patients were found to have experienced recurrence after conversion surgery. Especially, peritoneal recurrence was observed in 50% of patients as the initial recurrence pattern. The median recurrence-free survival time was 9.2 (range, 5.1-32.8) months, and three patients have survived without recurrence to date.
CONCLUSIONS
Our IP therapy displays promising clinical efficacy with acceptable tolerability in patients with PDAC and peritoneal metastasis. Although we could observe some super-responders in the cohort, further improvements in IP therapy are warranted.
背景
胰腺导管腺癌（PDAC）是全球致死率最高的恶性肿瘤之一。我们之前探讨了腹腔内（IP）紫杉醇治疗PDAC伴腹膜转移患者的临床疗效，结果显示有良好的反应率和疾病控制率。然而，IP治疗后进行转化手术的实际意义仍不明确。
方法
我们开展了两项关于PDAC伴腹膜转移患者IP紫杉醇治疗的多中心临床试验。我们重点关注接受转化手术的患者，并调查其长期预后，特别是初始复发模式和长期生存情况。
结果
79例PDAC伴腹膜转移患者接受了治疗，33例（41.8%）患者接受了SP（静脉注射IP紫杉醇联合S-1）治疗，46例（58.3%）患者接受了GAP（静脉注射吉西他滨+纳米白蛋白结合型紫杉醇联合IP紫杉醇）联合治疗。79例患者中，16例（20.3%）接受了转化手术。化疗开始后至手术的中位时间为9.0（范围4.1 - 13.0）个月。最终，13例（81.3%）患者接受了R0切除。Evans分级为IIA级的患者9例，IIB级4例，III级2例，IV级1例。接受转化手术患者的中位总生存时间为32.5（范围13.5 - 66.9）个月。12例（75.0%）患者在转化手术后出现复发。特别是，50%的患者初始复发模式为腹膜复发。中位无复发生存时间为9.2（范围5.1 - 32.8）个月，目前有3例患者存活且未复发。
结论
我们的IP治疗在PDAC伴腹膜转移患者中显示出有前景的临床疗效和可接受的耐受性。尽管我们在该队列中观察到了一些超反应者，但IP治疗仍需进一步改进。
Zotero 插件