新辅助化疗与行胰十二指肠切除术联合血管切除的胰腺癌患者无病生存期的改善相关。

Neoadjuvant chemotherapy is associated with improved disease-free survival in pancreatic cancer patients undergoing pancreaticoduodenectomy with vascular resection.

机构信息

Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, USA.

Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, California, USA.

出版信息

J Surg Oncol. 2024 Jul;130(1):72-82. doi: 10.1002/jso.27674. Epub 2024 May 10.

DOI:10.1002/jso.27674

PMID:38726668

Abstract

BACKGROUND AND OBJECTIVES

Neoadjuvant chemotherapy (NAC) is becoming favored for all pancreatic adenocarcinoma (PDAC). Patients with seemingly resectable disease infrequently still display vascular involvement intraoperatively. Outcomes following NAC versus upfront surgery in patients undergoing pancreaticoduodenectomy (PD) with vascular resection are unknown.

METHODS

We performed a retrospective cohort study of PDAC patients who underwent PD with vascular resection between January 1, 2013, to December 31, 2020, within a single academic center. Clinicopathologic characteristics and disease-free survival (DFS) were compared between NAC versus upfront surgery cohorts using the Kaplan-Meier estimate and Cox proportional-hazards regression model.

RESULTS

Eighty-one patients who underwent PD with vascular resection for PDAC were included. Forty-six patients (56%) received NAC. The NAC cohort more often had pathologic N0 status (47.8% vs. 8.6%, p < 0.001), had decreased vascular invasion (11% vs. 40%, p = 0.002), and completed chemotherapy (80% vs. 40%, p < 0.01). The NAC cohort demonstrated improved DFS (40.5 vs. 14.3 months, p = 0.007). In multivariable analysis, NAC remained independently associated with increased DFS (HR = 0.48, p = 0.02).

CONCLUSIONS

NAC was associated with improved clinicopathologic outcomes and DFS in PD with vascular resection. These findings demonstrate the advantage of NAC in PDAC patients undergoing PD with vascular resection.

摘要

背景与目的

新辅助化疗（NAC）越来越受到胰腺导管腺癌（PDAC）患者的青睐。对于看似可切除的疾病，患者在手术中仍常出现血管侵犯。接受胰腺十二指肠切除术（PD）联合血管切除的患者，NAC 与直接手术的结局尚不清楚。

方法

我们对 2013 年 1 月 1 日至 2020 年 12 月 31 日期间，在单一学术中心内接受 PD 联合血管切除的 PDAC 患者进行了回顾性队列研究。采用 Kaplan-Meier 估计和 Cox 比例风险回归模型比较 NAC 与直接手术队列的临床病理特征和无病生存（DFS）。

结果

共纳入 81 例因 PDAC 行 PD 联合血管切除的患者。其中 46 例（56%）接受了 NAC。NAC 组病理 N0 状态的比例更高（47.8%比 8.6%，p<0.001），血管侵犯程度较低（11%比 40%，p=0.002），且完成化疗的比例更高（80%比 40%，p<0.01）。NAC 组的 DFS 更好（40.5 比 14.3 个月，p=0.007）。多变量分析显示，NAC 与 DFS 的改善独立相关（HR=0.48，p=0.02）。