Son Jimin, Lee Woohyung, Lee Jung Bok, Hong Kwangpyo, Sung Min Kyu, Park Yejong, Jun Eunsung, Song Ki Byung, Hwang Dae Wook, Lee Jae Hoon, Kim Song Cheol
Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Ulsan College of Medicine, Asan Medical Center.
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Int J Surg. 2024 Nov 1;110(11):7080-7087. doi: 10.1097/JS9.0000000000001927.
The current AJCC 8th has been reported to have a poor ability to predict the prognosis in patients with resected borderline resectable pancreatic cancer and locally advanced pancreatic cancer following neoadjuvant chemotherapy. This study aimed to develop an improved prognostic model by incorporating pathology and parameters of biologic response (BR).
A retrospective cohort study was conducted including patients who underwent curative-intent surgery following chemotherapy. The authors developed a modified ypT staging system and incorporated the BR, involving normalization of carbohydrate antigen 19-9 and reduction in the maximum standardized uptake value simultaneously after chemotherapy. The prognostic performance of the current pathologic system, modified pathologic system, and newly developed system incorporating pathology and BR were compared.
In this study, 171 patients underwent surgery following chemotherapy. The modified T stage, which unified ypT2 and ypT3, demonstrated improved prognostic performance than the current staging system [area under the curve (AUC): 0.706 vs. 0.661]. Biologic unresponsiveness was an independent prognostic factor for worse survival (hazard ratio 2.31, 95% CI: 1.50-3.55, P <0.001). The modified pathology with BR system demonstrated the highest discriminative ability in predicting 5-year overall survival than the current pathologic system (AUC: 0.785 vs. 0.661, P =0.010) and modified pathologic staging system (AUC: 0.785 vs. 0.706, P =0.002).
The prognostic model, incorporating modified ypT staging and elevated carbohydrate antigen 19-9 levels and maximum standardized uptake value simultaneously, demonstrated improved results in predicting oncologic outcomes for patients who underwent surgery following neoadjuvant chemotherapy.
据报道，当前的美国癌症联合委员会（AJCC）第8版在预测新辅助化疗后可切除的边缘可切除胰腺癌和局部晚期胰腺癌患者的预后方面能力欠佳。本研究旨在通过纳入病理学和生物学反应（BR）参数来开发一种改进的预后模型。
进行了一项回顾性队列研究，纳入化疗后接受根治性手术的患者。作者开发了一种改良的ypT分期系统，并纳入了BR，包括化疗后同时使糖类抗原19-9正常化和最大标准摄取值降低。比较了当前病理系统、改良病理系统以及新开发的纳入病理学和BR的系统的预后性能。
在本研究中，171例患者化疗后接受手术。统一了ypT2和ypT3的改良T分期，与当前分期系统相比，显示出更好的预后性能[曲线下面积（AUC）：0.706对0.661]。生物学无反应是生存较差的独立预后因素（风险比2.31，95%置信区间：1.50 - 3.55，P<0.001）。与当前病理系统（AUC：0.785对0.661，P = 0.010）和改良病理分期系统（AUC：0.785对
