Murakami Masatoshi, Fujimori Nao, Ohno Akihisa, Matsumoto Kazuhide, Teramatsu Katsuhito, Takamatsu Yu, Takeno Ayumu, Oono Takamasa, Abe Toshiya, Ideno Noboru, Ikenaga Naoki, Nakata Kohei, Nakamura Masafumi, Ishigami Kousei, Ogawa Yoshihiro
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Discov Oncol. 2022 Jan 3;13(1):2. doi: 10.1007/s12672-021-00462-1.
BACKGROUND/AIMS: Recently neoadjuvant chemotherapy (NAC) for pancreatic cancer has been shown to be superior to upfront surgery, but it remains a matter of debate for resectable cases. In clinical practice, some resectable cases may become unresectable after NAC. This study aimed to reveal the outcomes after NAC and to clarify the characteristics of unresected cases.
The medical records of 142 patients who underwent NAC between 2016 and 2020 were retrospectively reviewed. Patient characteristics, effectiveness of NAC, and outcomes were compared between the surgical group and non-surgical group (NSG). Furthermore, the risk of recurrence limited to in the patients who received NAC with gemcitabine plus nab-paclitaxel, which were mostly administered in this cohort, following R0/R1 resection was assessed.
The overall and R0 resection rates after NAC were 89.1% and 79.7%, respectively. The neutrophil to lymphocyte ratio (NLR) > 2.78 (p = 0.0120) and anatomical borderline resectable pancreatic cancer (p = 0.0044) revealed a statistically significantly correlation with the NSG. On the other hand, NAC week < 8 (p = 0.0285), radiological response, stable disease or progression disease (p = 0.0212), and pathological stage > IIA (P = 0.0003) were significantly associated with recurrence. The tumor response rate was approximately 26.1%, and three patients with ≥ 30% reduction of primary tumor lost excision opportunities because of metastasis, interstitial pneumonia, and vascular invasion.
This study shows incomplete tumor shrinkage benefits, but pre-NAC NLR is a predictive factor for predicting operability after NAC. The NLR can be easily calculated by normal blood test, and can be considered as a suitable marker of operability.
背景/目的：近期研究表明，胰腺癌新辅助化疗（NAC）优于直接手术，但对于可切除病例仍存在争议。在临床实践中，一些可切除病例在接受NAC后可能变为不可切除。本研究旨在揭示NAC后的治疗结果，并阐明未接受手术病例的特征。
回顾性分析2016年至2020年间接受NAC的142例患者的病历。比较手术组和非手术组（NSG）的患者特征、NAC疗效及治疗结果。此外，评估了在本队列中大多接受吉西他滨联合白蛋白结合型紫杉醇NAC治疗的患者，在R0/R1切除术后局限于复发的风险。
NAC后的总切除率和R0切除率分别为89.1%和79.7%。中性粒细胞与淋巴细胞比值（NLR）>2.78（p = 0.0120）和解剖学上临界可切除胰腺癌（p = 0.0044）与NSG存在统计学显著相关性。另一方面，NAC疗程<8周（p = 0.0285）、放射学反应、疾病稳定或进展（p = 0.0212）以及病理分期>IIA期（P = 0.0003）与复发显著相关。肿瘤反应率约为26.1%，3例原发肿瘤缩小≥30%的患者因转移、间质性肺炎和血管侵犯而失去切除机会。
本研究显示了肿瘤不完全缩小的益处，但NAC前的NLR是预测NAC后可手术性的一个预测因素。NLR可通过常规血液检查轻松计算，可被视为合适的可手术性标志物。
