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.
J Surg Oncol. 2023 Jul;128(1):41-50. doi: 10.1002/jso.27265. Epub 2023 Apr 11.
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.
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.
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.
CA19-9 normalization after NACT is a clinically significant endpoint of treatment; patients without CA19-9 normalization may benefit from additional therapy.
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。
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。
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。
NACT 后 CA19-9 正常化是治疗的一个有临床意义的终点；未发生 CA19-9 正常化的患者可能受益于额外的治疗。
