Tong Yi Tat, Lai Zongshan, Katz Matthew H G, Prakash Laura R, Wang Hua, Chatterjee Deyali, Kim Michael, Tzeng Ching-Wei D, Lee Jeffrey E, Ikoma Naruhiko, Rashid Asif, Wolff Robert A, Zhao Dan, Koay Eugene J, Maitra Anirban, Wang Huamin
Department of Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Cancers (Basel). 2023 May 4;15(9):2608. doi: 10.3390/cancers15092608.
Neoadjuvant FOLFIRINOX and gemcitabine/nab-paclitaxel (GemNP) therapies are increasingly used to treat patients with pancreatic ductal adenocarcinoma (PDAC). However, limited data are available on their clinicopathologic prognosticators. We examined the clinicopathologic factors and survival of 213 PDAC patients who received FOLFIRINOX with 71 patients who received GemNP. The FOLFIRINOX group was younger ( < 0.01) and had a higher rate of radiation ( = 0.049), higher rate of borderline resectable and locally advanced disease ( < 0.001), higher rate of Group 1 response ( = 0.045) and lower ypN stage ( = 0.03) than the GemNP group. Within FOLFIRINOX group, radiation was associated with decreased lymph node metastasis ( = 0.01) and lower ypN stage ( = 0.01). The tumor response group, ypT, ypN, LVI and PNI, correlated significantly with both DFS and OS ( < 0.05). Patients with the ypT0/T1a/T1b tumor had better DFS ( = 0.04) and OS ( = 0.03) than those with ypT1c tumor. In multivariate analysis, the tumor response group and ypN were independently prognostic factors for DFS and OS ( < 0.05). Our study demonstrated that the FOLFIRINOX group was younger and had a better pathologic response than the GemNP group and that the tumor response group, ypN, ypT, LVI and PNI, are significant prognostic factors for survival in these patients. Our results also suggest that the tumor size of 1.0 cm is a better cut off for ypT2. Our study highlights the importance of systemic pathologic examination and the reporting of post-treatment pancreatectomies.
新辅助FOLFIRINOX方案和吉西他滨/纳米白蛋白结合型紫杉醇（GemNP）疗法越来越多地用于治疗胰腺导管腺癌（PDAC）患者。然而，关于其临床病理预后因素的数据有限。我们研究了213例接受FOLFIRINOX方案治疗的PDAC患者以及71例接受GemNP治疗的患者的临床病理因素和生存情况。FOLFIRINOX组患者较年轻（P<0.01），放疗率较高（P=0.049），边界可切除和局部晚期疾病的发生率较高（P<0.001），1组反应率较高（P=0.045），ypN分期较低（P=0.03），均优于GemNP组。在FOLFIRINOX组中，放疗与淋巴结转移减少（P=0.01）和ypN分期降低（P=0.01）相关。肿瘤反应组、ypT、ypN、淋巴管浸润（LVI）和神经周围浸润（PNI）与无病生存期（DFS）和总生存期（OS）均显著相关（P<0.05）。ypT0/T1a/T1b肿瘤患者的DFS（P=0.04）和OS（P=0.03）均优于ypT1c肿瘤患者。多因素分析显示，肿瘤反应组和ypN是DFS和OS的独立预后因素（P<0.05）。我们的研究表明，FOLFIRINOX组患者较年轻，病理反应优于GemNP组，肿瘤反应组、ypN、ypT、LVI和PNI是这些患者生存的重要预后因素。我们的结果还表明，对于ypT2，肿瘤大小1.0 cm是更好的截断值。我们的研究强调了系统病理检查以及报告治疗后胰腺切除术的重要性。
