Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy.
Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy.
Updates Surg. 2023 Sep;75(6):1497-1508. doi: 10.1007/s13304-023-01628-y. Epub 2023 Aug 14.
Neoadjuvant therapy (NAT) + surgical resection for pancreatic cancer (PC) has gained consensus in recent years. Pathological response (PR) is generally assessed according to the College of American Pathologists grading system, ranging from 0 (complete response) to 3 (no response). The aim of our study is to evaluate the PR in a series of resections for PC after NAT and its prognostic implication. 112 patients undergone NAT and resection for PC between 2011 and 2020 were retrospectively evaluated. PR was 0/1, 2 and 3 in 18 (15%), 79 (61%) and 29 (24%) cases, respectively. Chemotherapy regimens different from FOLFIRINOX and gemcitabine + nab-paclitaxel (OR 11.61 (2.53-53.36), p = 0.002) and lymphovascular invasion (OR 11.28 (1.89-67.23), p = 0.008) were associated to PR-3. Median follow-up was 25.8 (3.6-130.5) months. For PR-0/1, PR-2 and PR-3, median DFS was 45.8, 11.5, 4.6 months (p < 0.0001), respectively, while median OS was not reached, 27.1 and 17.5 months (p = 0.0006), respectively. At univariate analysis, PR-0/1 was significantly associated to better DFS and OS (HR 0.33 (0.17-0.67), p = 0.002; HR 0.20 (0.07-0.54), p = 0.002, respectively). At multivariate analysis, pancreaticoduodenectomy (HR 0.50 (0.30-0.84), p = 0.009), LNR (HR 27.14 (1.21-608.9), p = 0.038) and lymphovascular invasion (HR 1.99 (1.06-3.76), p = 0.033) were independently associated to DFS; pre-treatment CA 19.9 value (HR 1.00 (1.00-1.00), p = 0.025), post-treatment resectability status (HR 0.51 (0.28-0.95), p = 0.035), pancreaticoduodenectomy (HR 0.56 (0.32-0.99), p = 0.050), severe morbidity (2.99 (1.22-7.55), p = 0.017), LNR (HR 56.8 (2.08-1548.3), p = 0.017), lymphovascular invasion (HR 2.18 (1.08-4.37), p = 0.029) were independently associated to OS. PR did not reach statistical significance at multivariate analysis. A favorable PR is observed only in a limited number of cases. The prognostic role of PR, despite being promising, remains unclear and further multicentric studies are needed.
新辅助治疗（NAT）联合胰腺切除术（PC）近年来已达成共识。病理反应（PR）通常根据美国病理学家协会分级系统进行评估，范围从 0（完全反应）到 3（无反应）。我们的研究旨在评估一系列经 NAT 治疗后行胰腺切除术患者的 PR 及其预后意义。回顾性分析了 2011 年至 2020 年间接受 NAT 和 PC 切除术的 112 例患者。PR 为 0/1、2 和 3 的患者分别为 18（15%）、79（61%）和 29（24%）例。与 FOLFIRINOX 和吉西他滨+nab-紫杉醇（OR 11.61（2.53-53.36），p=0.002）和血管淋巴管侵犯（OR 11.28（1.89-67.23），p=0.008）不同的化疗方案与 PR-3 相关。中位随访时间为 25.8（3.6-130.5）个月。对于 PR-0/1、PR-2 和 PR-3，中位 DFS 分别为 45.8、11.5 和 4.6 个月（p<0.0001），中位 OS 分别为未达到、27.1 和 17.5 个月（p=0.0006）。单因素分析显示，PR-0/1 与更好的 DFS 和 OS 显著相关（HR 0.33（0.17-0.67），p=0.002；HR 0.20（0.07-0.54），p=0.002）。多因素分析显示，胰十二指肠切除术（HR 0.50（0.30-0.84），p=0.009）、淋巴结比值（HR 27.14（1.21-608.9），p=0.038）和血管淋巴管侵犯（HR 1.99（1.06-3.76），p=0.033）与 DFS 独立相关；治疗前 CA 19.9 值（HR 1.00（1.00-1.00），p=0.025）、治疗后可切除性状态（HR 0.51（0.28-0.95），p=0.035）、胰十二指肠切除术（HR 0.56（0.32-0.99），p=0.049）、严重发病率（HR 2.99（1.22-7.55），p=0.017）、淋巴结比值（HR 56.8（2.08-1548.3），p=0.017）和血管淋巴管侵犯（HR 2.18（1.08-4.37），p=0.029）与 OS 独立相关。PR 在多因素分析中未达到统计学意义。仅在有限数量的病例中观察到有利的 PR。尽管 PR 的预后作用很有希望，但仍不清楚，需要进一步的多中心研究。
