Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: https://twitter.com/MimmoTamburrino.
Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Surgery. 2024 Nov;176(5):1458-1465. doi: 10.1016/j.surg.2024.07.026. Epub 2024 Aug 27.
Pathologic complete response after neoadjuvant treatment in pancreatic ductal adenocarcinoma is a rare occurrence. Similar to other malignancies, achieving a pathologic complete response in pancreatic ductal adenocarcinoma seems to correlate with improved survival. However, because of the rarity of such events, the true significance of pathologic complete response in pancreatic cancer remains unclear. The aim of the present study was to investigate the impact of pathologic complete response on survival and recurrence.
In a single-center retrospective study, pathologic complete response was defined as no evidence of viable tumor cells in resected specimen entirely sampled according to a rigorous protocol and in which a residual tumor bed was identified. Disease-specific survival and disease-free survival were measured from surgery. Independent predictors for disease-specific survival and disease-free survival were examined.
Overall, 403 patients were included. Pathologic complete response was found in 15 patients (3.8%), after chemotherapy alone. After a median follow-up of 42 months (95% CI 38-45), 3-year disease-specific survival was 87% in pathologic complete response patients vs 43% in those without pathologic complete response (P = .014). The recurrence rate was 40% (n = 6/15) in the pathologic complete response group compared with 69.8% (n = 271/388) in those without pathologic complete response. Disease-free survival was longer in the pathologic complete response group, with higher 1- and 3-year rates compared with the no-pathologic complete response group (80% vs 60% and 48% vs 24%, respectively). Pathologic complete response was found to be an independent protective factor for disease-specific survival (P = .035) but not for disease-free survival (P = .052).
Pathologic complete response in pancreatic ductal adenocarcinoma is not synonymous of cure but ensure a prolonged survival. Nevertheless, recurrence remains a significant concern, with high rates observed even among these exceptional responders.
新辅助治疗后胰腺导管腺癌完全病理缓解是一种罕见的情况。与其他恶性肿瘤类似，胰腺导管腺癌完全病理缓解似乎与生存改善相关。然而，由于这种情况非常罕见，完全病理缓解在胰腺癌中的真正意义仍不清楚。本研究旨在探讨完全病理缓解对生存和复发的影响。
在一项单中心回顾性研究中，完全病理缓解定义为根据严格的方案完全取样的切除标本中无存活肿瘤细胞的证据，并且识别出残留的肿瘤床。从手术开始测量疾病特异性生存和无病生存。检查疾病特异性生存和无病生存的独立预测因子。
共有 403 例患者入组。15 例（3.8%）患者在单独化疗后发现完全病理缓解。在中位随访 42 个月（95%CI 38-45）后，完全病理缓解患者的 3 年疾病特异性生存率为 87%，而无完全病理缓解患者为 43%（P=.014）。完全病理缓解组的复发率为 40%（n=6/15），而无完全病理缓解组为 69.8%（n=271/388）。完全病理缓解组的无病生存率较长，1 年和 3 年的生存率均高于无完全病理缓解组（80%比 60%和 48%比 24%）。完全病理缓解被发现是疾病特异性生存的独立保护因素（P=.035），但不是无病生存的保护因素（P=.052）。
胰腺导管腺癌的完全病理缓解不是治愈的同义词，但可确保延长生存。然而，复发仍然是一个重要的问题，即使在这些罕见的缓解者中，也观察到高复发率。
