新辅助化疗治疗胰腺癌：质量优于数量。

Neoadjuvant chemotherapy for pancreatic cancer: Quality over quantity.

机构信息

Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Department of Medicine, Division of Medical Oncology, LaBahn Pancreatic Cancer Program , Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

出版信息

J Surg Oncol. 2023 Jul;128(1):41-50. doi: 10.1002/jso.27265. Epub 2023 Apr 11.

DOI:10.1002/jso.27265

PMID:36960919

Abstract

BACKGROUND AND OBJECTIVES

The ideal duration of neoadjuvant chemotherapy (NACT) in patients with localized pancreatic adenocarcinoma (PDAC) treated with curative intent is unclear. We sought to determine the prognostic significance of both duration of NACT and Carbohydrate Antigen 19-9 (CA19-9) normalization to NACT.

METHODS

We examined patients with resectable and borderline resectable PDAC treated with NACT and chemoradiation. Patients were compared by NACT duration (2 vs. 4 months) and by CA19-9 normalization after NACT.

RESULTS

Among 171 patients, 83 (49%) received 2 months of NACT, and 88 (51%) received 4 months. After NACT completion, 115 (67%) patients had persistently elevated CA19-9, and 56 (33%) had normalized. Of the 125 patients who had successful surgery, 73 (58%) had normalized CA19-9 postoperatively. Duration of NACT was not associated with overall survival (OS) while CA19-9 normalization after NACT (regardless of duration) was associated with improved OS (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.35-0.89, p = 0.02). Adjuvant chemotherapy was associated with improved OS among patients without CA19-9 normalization after NACT (HR 0.42, CI 0.20-0.86, p = 0.02) but not among those that normalized, independent of duration.

CONCLUSIONS

CA19-9 normalization after NACT is a clinically significant endpoint of treatment; patients without CA19-9 normalization may benefit from additional therapy.

摘要

背景与目的

接受根治性治疗的局限性胰腺导管腺癌（PDAC）患者新辅助化疗（NACT）的理想持续时间尚不清楚。我们旨在确定 NACT 持续时间和碳水化合物抗原 19-9（CA19-9）对 NACT 正常化的预后意义。

方法

我们检查了接受 NACT 和放化疗的可切除和边缘可切除 PDAC 患者。根据 NACT 持续时间（2 个月与 4 个月）和 NACT 后 CA19-9 正常化对患者进行比较。

结果

在 171 例患者中，83 例（49%）接受了 2 个月的 NACT，88 例（51%）接受了 4 个月的 NACT。NACT 完成后，115 例（67%）患者的 CA19-9 持续升高，56 例（33%）患者 CA19-9 正常化。在 125 例成功进行手术的患者中，73 例（58%）患者术后 CA19-9 正常化。NACT 持续时间与总生存期（OS）无关，而 NACT 后 CA19-9 正常化（无论持续时间如何）与 OS 改善相关（风险比 [HR] 0.56，95%置信区间 [CI] 0.35-0.89，p=0.02）。NACT 后 CA19-9 未正常化的患者接受辅助化疗与 OS 改善相关（HR 0.42，CI 0.20-0.86，p=0.02），但在 CA19-9 正常化的患者中则不然，且与持续时间无关。