Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Goodjang Hospital, Seoul, Republic of Korea.
J Hepatobiliary Pancreat Sci. 2023 Jul;30(7):924-934. doi: 10.1002/jhbp.1302. Epub 2023 Mar 13.
BACKGROUND/PURPOSE: The efficacy of neoadjuvant treatment (NAT) for resectable pancreatic cancer remains debatable, particularly in patients with portal vein (PV)/superior mesenteric vein (SMV) contact and elevated serum carbohydrate antigen (CA) 19-9. This study investigated the clinical significance of PV/SMV contact and CA19-9 levels, and the role of NAT in resectable pancreatic cancer.
A total of 775 patients who underwent surgery for resectable pancreatic cancer between 2007 and 2018 were included. Propensity score-matched (PSM) analysis (1:3) was performed based on tumor size, lymph node enlargement, and PV/SMV contact. Subgroup analyses were performed according to PV/SMV contact and CA19-9 level.
Among the patients, 52 underwent NAT and 723 underwent upfront surgery. After PSM, NAT group showed better survival than upfront surgery group (median 30.0 vs 22.0 months, P = .047). In patients with PV/SMV contact, NAT tended to have better survival (30.0 vs 22.0 months, P = .069). CA19-9 >150 U/mL was a poor prognostic factor, with NAT showing a significant survival difference compared with upfront surgery (34.0 vs 18.0 months, P = .004).
Neoadjuvant treatment showed better survival than upfront surgery in resectable pancreatic cancer. In patients with PV/SMV contact or CA19-9 >150 U/mL, NAT showed a survival difference compared to upfront surgery; therefore, NAT could be considered in these patients.
背景/目的：新辅助治疗（NAT）对于可切除的胰腺癌的疗效仍存在争议，尤其是在门静脉（PV）/肠系膜上静脉（SMV）受侵和血清碳水化合物抗原（CA）19-9 升高的患者中。本研究旨在探讨 PV/SMV 接触和 CA19-9 水平的临床意义，以及 NAT 在可切除胰腺癌中的作用。
回顾性分析了 2007 年至 2018 年间接受手术治疗的 775 例可切除胰腺癌患者的临床资料。根据肿瘤大小、淋巴结肿大和 PV/SMV 接触情况，采用倾向评分匹配（PSM）分析（1:3）。根据 PV/SMV 接触和 CA19-9 水平进行亚组分析。
在这 775 例患者中，52 例患者接受了 NAT，723 例患者接受了 upfront 手术。经过 PSM 后，NAT 组的生存情况优于 upfront 手术组（中位生存时间 30.0 个月 vs 22.0 个月，P=0.047）。在有 PV/SMV 接触的患者中，NAT 组的生存情况有改善趋势（30.0 个月 vs 22.0 个月，P=0.069）。CA19-9＞150 U/mL 是一个不良预后因素，与 upfront 手术相比，NAT 组的生存差异有统计学意义（34.0 个月 vs 18.0 个月，P=0.004）。
与 upfront 手术相比，NAT 可改善可切除胰腺癌患者的生存情况。在有 PV/SMV 接触或 CA19-9＞150 U/mL 的患者中，NAT 与 upfront 手术的生存情况存在差异，因此可以考虑在这些患者中应用 NAT。
