Amirian Haleh, Dickey Erin, Ogobuiro Ifeanyichukwu, Box Edmond W, Shah Ankit, Martos Mary P, Patel Manan, Wilson Gregory C, Snyder Rebecca A, Parikh Alexander A, Hammill Chet, Kim Hong J, Abbott Daniel, Maithel Shishir K, Zafar Syed Nabeel, LeCompte Michael T, Kooby David A, Ahmad Syed A, Merchant Nipun B, Hester Caitlin A, Datta Jashodeep
Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Surg Oncol. 2024 Oct;130(5):1023-1032. doi: 10.1002/jso.27798. Epub 2024 Aug 21.
In patients with localized pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant therapy (NAT) and resection, selection of adjuvant chemotherapy (AC) is typically guided by high-risk features on histopathologic examination. We evaluated the interaction between post-NAT lymph node metrics and AC receipt on survival.
Patients who received NAT followed by pancreatectomy (2010-2020) at seven centers were reviewed. Overall survival (OS) in patients receiving AC or not was stratified by lymph node positivity (LNP) or lymph node ratio (LNR) dichotomized at 0.1. Cox models evaluated the independent association between these nodal metrics, AC receipt, and OS.
Of 464 patients undergoing NAT and resection, 264 (57%) received AC. Patients selected for AC were younger (median 63 vs. 67 years; p < 0.001), received shorter duration of NAT (2.8 vs. 3.2 months; p = 0.01), had fewer postoperative complications (Clavien-Dindo grade > 3: 1.2% vs. 11.7%; p < 0.001), and lower rates of pathologic complete response (4% vs. 11%; p = 0.01). The median number of nodes evaluated was similar between cohorts (n = 20 in both; p = 0.9). Post-NAT LNP rates were not different, and median LNR was 0.1, in AC and non-AC cohorts. Both LNP (hazard ratio [HR]: 2.1, p < 0.001) and LNR (0 < LNR ≤ 0.1: HR: 1.98, p = 0.002; LNR > 0.1: HR 2.46, p < 0.001) were independently associated with OS on Cox modeling, although receipt of AC was not associated with improved OS (median 30.6 vs. 29.4 months; p = 0.2). In patients with LNR > 0.1, receipt of AC was associated with significantly longer OS compared to non-AC (24 vs. 20 months, respectively; p = 0.04).
LNR following NAT, not simply nodal positivity, may be useful to refine selection of AC in resected PDAC.
在接受新辅助治疗（NAT）和手术切除的局限性胰腺导管腺癌（PDAC）患者中，辅助化疗（AC）的选择通常以组织病理学检查中的高危特征为指导。我们评估了NAT后淋巴结指标与接受AC对生存的相互作用。
回顾了7个中心在2010年至2020年期间接受NAT后行胰腺切除术的患者。接受或未接受AC的患者的总生存期（OS）按淋巴结阳性（LNP）或淋巴结比率（LNR）二分法分为0.1进行分层。Cox模型评估了这些淋巴结指标、接受AC与OS之间的独立关联。
在464例接受NAT和手术切除的患者中，264例（57%）接受了AC。被选择接受AC的患者更年轻（中位年龄63岁对67岁；p<0.001），接受NAT的时间更短（2.8个月对3.2个月；p=0.01），术后并发症更少（Clavien-Dindo分级>3级：1.2%对11.7%；p<0.001），病理完全缓解率更低（4%对11%；p=0.01）。两组评估的淋巴结中位数相似（均为n=20；p=0.9）。AC组和非AC组NAT后的LNP率无差异，LNR中位数为0.1。在Cox模型中，LNP（风险比[HR]：2.1，p<0.001）和LNR（0<LNR≤0.1：HR：1.98，p=0.002；LNR>0.1：HR 2.46，p<0.001）均与OS独立相关，尽管接受AC与OS改善无关（中位生存期30.6个月对29.4个月；p=0.2）。在LNR>0.1的患者中，与未接受AC相比，接受AC与显著更长的OS相关（分别为24个月对20个月；p=0.04）。
NAT后的LNR，而非单纯的淋巴结阳性，可能有助于优化切除的PDAC中AC的选择。
