Hua Surong, Gao Junyi, Xu Qiang, Hong Xiafei, Wu Wenming
Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Gland Surg. 2022 Feb;11(2):494-503. doi: 10.21037/gs-22-6.
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers worldwide. Radical resection is currently the only potential curative treatment. However, over 80% of patients present with unresectable tumor at the time of diagnosis. It is recommended that patients with unresectable pancreatic cancers be offered neoadjuvant treatment. A combination of gemcitabine and S-1 (GS-1) has been reported to be an effective regimen for unresectable pancreatic cancers, however, there have been no reports of pathological complete response up until now.
Herein, we present a 67-year-old male who presented with a 4-month history of upper abdominal and back pain, as well as unintentional weight loss. Abdominal computed tomography (CT) confirmed a hypovascular mass in the pancreas neck consistent with unresectable pancreatic cancer. Positron emission tomography (PET)/CT also revealed a high fludeoxyglucose (FDG)-avid lesion in the pancreas neck without evidence of distant metastasis. Pancreatic adenocarcinoma was confirmed with ultrasound-guided fine-needle aspiration cytology. The patient was recommended to undergo treatment with gemcitabine and S-1. After 5 cycles of neoadjuvant chemotherapy, CT and PET/CT both revealed the disappearance of the lesion and a pancreaticoduodenectomy was offered as a potentially curative treatment. Histological assessment revealed no evidence of residual adenocarcinoma [ypT0N0 (0/38)]. The tumor marker cancer antigen (CA)125 increased one month after the surgery, resulting in two additional cycles of GS-1. This patient remained disease-free for 21 months after surgery.
This report is the first to present a case of a pathological complete response in a patient with locally advanced pancreatic cancer following GS-1 treatment, suggesting radical resection after GS-1 chemotherapy might be a potential curative treatment strategy for unresectable PDAC.
胰腺导管腺癌（PDAC）是全球致死率最高的癌症之一。根治性切除是目前唯一可能治愈的治疗方法。然而，超过80%的患者在诊断时就已出现无法切除的肿瘤。建议对无法切除的胰腺癌患者进行新辅助治疗。据报道，吉西他滨和S-1（GS-1）联合使用是治疗无法切除胰腺癌的有效方案，但迄今为止尚无病理完全缓解的报道。
在此，我们报告一名67岁男性，有4个月的上腹部和背部疼痛病史，以及非故意体重减轻。腹部计算机断层扫描（CT）证实胰腺颈部有一个低血供肿块，符合无法切除的胰腺癌。正电子发射断层扫描（PET）/CT也显示胰腺颈部有一个高氟脱氧葡萄糖（FDG）摄取的病变，无远处转移迹象。超声引导下细针穿刺细胞学检查确诊为胰腺腺癌。建议该患者接受吉西他滨和S-1治疗。经过5个周期的新辅助化疗后，CT和PET/CT均显示病变消失，并提供了胰十二指肠切除术作为潜在的治愈性治疗。组织学评估显示无残留腺癌证据[ypT0N0（0/38）]。术后1个月肿瘤标志物癌抗原（CA）125升高，因此又进行了两个周期的GS-1治疗。该患者术后无病生存21个月。
本报告首次展示了1例局部晚期胰腺癌患者在接受GS-1治疗后出现病理完全缓解的病例，提示GS-1化疗后根治性切除可能是无法切除的PDAC的一种潜在治愈性治疗策略。
