Jang Jong Keon, Byun Jae Ho, Choi Se Jin, Kim Jin Hee, Lee Seung Soo, Kim Hyoung Jung, Yoo Changhoon, Kim Kyu-Pyo, Hong Seung-Mo, Seo Dong-Wan, Hwang Dae Wook, Kim Song Cheol
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Ann Surg Oncol. 2025 Feb;32(2):1321-1330. doi: 10.1245/s10434-024-16437-9. Epub 2024 Nov 1.
This study aimed to assess the prognostic value of the National Comprehensive Cancer Network (NCCN) criteria for resection following neoadjuvant therapy for patients with localized pancreatic ductal adenocarcinoma (PDAC).
This retrospective single-center study assessed 193 consecutive patients with localized PDAC (104 males and 89 females; mean age, 61.1 ± 9.4 years) who underwent neoadjuvant therapy followed by surgery between January 2010 and March 2021. Combined resectability and carbohydrate antigen (CA) 19-9 evaluation before and after neoadjuvant therapy was used to determine whether patients were eligible for resection according to the NCCN criteria. Post-surgical overall survival (OS), recurrence free survival (RFS), and pathologic results were evaluated and compared between patients considered eligible according to the NCCN criteria and those considered ineligible. Preoperative factors associated with better OS and RFS also were investigated.
Of the 193 patients, 168 (87.0 %) were eligible for resection according to the NCCN criteria. The patients eligible according to the NCCN criteria showed marginally longer OS than those considered ineligible (p = 0.056). After adjustment of variables, meeting the NCCN criteria for resection was an independent predictor of better OS (hazard ratio, 0.57; 95 % confidence interval, 0.34-0.96; p = 0.034). The two groups had similar RFS. Lower T-staging (T2 or less) and less lympho-vascular invasion and peri-neural invasion were noted in the patients who met the NCCN criteria (p ≤ 0.045).
The patients eligible for resection according to the NCCN criteria showed a trend toward longer OS and better pathologic results than the patients considered ineligible.
本研究旨在评估美国国立综合癌症网络（NCCN）标准对局部胰腺癌（PDAC）患者新辅助治疗后切除的预后价值。
这项回顾性单中心研究评估了2010年1月至2021年3月期间193例连续接受新辅助治疗后手术的局部PDAC患者（104例男性和89例女性；平均年龄61.1±9.4岁）。根据新辅助治疗前后的联合可切除性和糖类抗原（CA）19-9评估，确定患者是否符合NCCN标准进行切除。对符合NCCN标准的患者和不符合标准的患者进行术后总生存期（OS）、无复发生存期（RFS）和病理结果的评估与比较。还研究了与更好的OS和RFS相关的术前因素。
193例患者中，168例（87.0%）符合NCCN标准可进行切除。符合NCCN标准的患者的OS略长于不符合标准的患者（p=0.056）。变量调整后，符合NCCN切除标准是更好OS的独立预测因素（风险比，0.57；95%置信区间，0.34-0.96；p=0.034）。两组的RFS相似。符合NCCN标准的患者T分期较低（T2或更低），且较少发生淋巴血管侵犯和神经周围侵犯（p≤0.045）。
符合NCCN标准可切除的患者比不符合标准的患者显示出OS更长和病理结果更好的趋势。
