Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Winfield, IL, USA.
Division of Surgical Oncology, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Winfield, IL, USA.
Pancreatology. 2023 Nov;23(7):805-810. doi: 10.1016/j.pan.2023.08.003. Epub 2023 Aug 16.
BACKGROUND/OBJECTIVES: Neoadjuvant chemotherapy (NCT) and chemoradiotherapy (NCRT) enhance resectability in patients with pancreatic adenocarcinoma (PDAC). This study compares the effect of NCT and NCRT on lymph nodal downstaging and survival.
The 2004-2016 National Cancer Database Pancreas Participant User File was used to identify patients who underwent surgery for PDAC. Fisher's exact, Wilcoxon rank-sum, multivariate logistic regression, and log-rank were used. Downstaging was defined as clinically node-positive patients who demonstrated node-negativity on pathology.
Of 42,545 patients meeting criteria, 3311 received NCT and 1511 received NCRT. After surgery for clinically node-positive disease, 23.3% of NCT patients and 41.3% of NCRT patients demonstrated nodal downstaging. Younger age and lower tumor grade independently predicted downstaging. Downstaging after neoadjuvant therapy was associated with improved survival versus no nodal treatment response (29.8 vs. 22.8 months, p < 0.001). Downstaging by NCT was associated with improved overall survival versus downstaging by NCRT (37.5 vs. 26.6 months, p = 0.001). No survival difference existed between those with no nodal response after NCT or NCRT (p = 0.101).
Although nodal downstaging is more likely post-NCRT, survival is superior in those downstaged post-NCT. Overall survival is determined by the systemic burden of disease. Post-therapy histologic analysis may be less prognostic post-NCRT.
背景/目的：新辅助化疗（NCT）和放化疗（NCRT）可提高胰腺腺癌（PDAC）患者的可切除性。本研究比较了 NCT 和 NCRT 对淋巴结降级和生存的影响。
使用 2004-2016 年国家癌症数据库胰腺参与者用户文件确定接受 PDAC 手术的患者。使用 Fisher 精确检验、Wilcoxon 秩和检验、多变量逻辑回归和对数秩检验。降级定义为临床淋巴结阳性患者，其病理学表现为淋巴结阴性。
在符合标准的 42545 名患者中，3311 名接受了 NCT，1511 名接受了 NCRT。在针对临床淋巴结阳性疾病进行手术后，23.3%的 NCT 患者和 41.3%的 NCRT 患者出现淋巴结降级。年龄较小和肿瘤分级较低独立预测降级。与无淋巴结治疗反应相比，新辅助治疗后的降级与生存改善相关（29.8 与 22.8 个月，p<0.001）。与 NCRT 相比，NCT 引起的降级与总体生存改善相关（37.5 与 26.6 个月，p=0.001）。NCT 或 NCRT 后无淋巴结反应的患者之间的生存差异无统计学意义（p=0.101）。
尽管 NCRT 后更可能出现淋巴结降级，但 NCT 后降级患者的生存情况更好。总生存取决于疾病的全身负担。治疗后组织学分析在 NCRT 后可能预后较差。
