新辅助治疗有助于胰腺癌的淋巴结降期。

Neoadjuvant therapy contributes to nodal downstaging of pancreatic cancer.

机构信息

Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan.

Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

出版信息

Langenbecks Arch Surg. 2022 Mar;407(2):623-632. doi: 10.1007/s00423-021-02339-x. Epub 2021 Oct 5.

DOI:10.1007/s00423-021-02339-x

PMID:34609618

Abstract

PURPOSE

This study aimed to assess the impact of neoadjuvant therapy (NAT) for borderline resectable or locally advanced pancreatic cancer (BR/LAPC) on the American Joint Commission on Cancer (AJCC) nodal status.

METHODS

The medical records of BR/LAPC patients who underwent surgery with curative intent were retrospectively reviewed. The nodal status was compared between patients who underwent upfront surgery (UFS) and those who received NAT. Moreover, clinicopathological factors and prognostic factors for overall survival were analyzed.

RESULTS

In all, 200 patients with BR/LAPC, 78 with UFS, and 122 with NAT were enrolled. The nodal status was significantly lower in patients after NAT than after UFS (p = 0.011). A multivariate analysis of overall survival showed that UFS (hazard ratio (HR) 1.61, p = 0.024) and N2 status (HR 2.69, p < 0.001) were independent poor prognostic factors. The median serum carbohydrate antigen (CA) 19-9 level after NAT in N2 patients was 105 U/mL, which was significantly higher than that of patients with N0 (p = 0.004) and N1 (p = 0.008) status.

CONCLUSION

Patients with BR/LAPC who underwent surgery after NAT had significantly lower N2 status and better prognosis than patients who underwent UFS. Elevated CA19-9 levels after NAT indicated a higher nodal status.

摘要

目的

本研究旨在评估新辅助治疗（NAT）对交界可切除或局部晚期胰腺癌（BR/LAPC）美国癌症联合委员会（AJCC）淋巴结状态的影响。

方法

回顾性分析了接受根治性手术的 BR/LAPC 患者的病历。比较了直接手术（UFS）和接受 NAT 治疗的患者的淋巴结状态。此外，还分析了总生存的临床病理因素和预后因素。

结果

共纳入 200 例 BR/LAPC 患者，其中 78 例行 UFS，122 例行 NAT。NAT 后患者的淋巴结状态明显低于 UFS 后（p=0.011）。总生存的多因素分析显示，UFS（风险比（HR）1.61，p=0.024）和 N2 状态（HR 2.69，p<0.001）是独立的不良预后因素。N2 患者 NAT 后血清碳水化合物抗原（CA）19-9 水平中位数为 105 U/mL，明显高于 N0（p=0.004）和 N1（p=0.008）状态患者。