Sulciner Megan L, Bailey Mandisa, Ruan Mengyuan, Fairweather Mark, Clancy Thomas E, Ashley Stanley W, Gold Jason S, Wang Jiping, Molina George
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Cureus. 2024 Nov 12;16(11):e73524. doi: 10.7759/cureus.73524. eCollection 2024 Nov.
Background Complete pathologic response following neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) is rare; alternative markers associated with survival are needed. The aim of this study was to evaluate the impact of tumor response to NAT on overall survival (OS) in PDAC patients who received NAT and curative-intent surgery. Methods A retrospective study utilizing the 2006-2018 National Cancer Database identified 6,960 adult patients with PDAC who received NAT. As a comparator group, 15,799 patients who underwent upfront surgical resection were separately analyzed. Primary outcome among patients who received NAT was OS according to changes in pathologic T and N staging compared to clinical T and N staging following NAT, defined as favorable response (downstaging) and non-favorable response (no change and upstaging). Results After NAT, 35.1%, 43.4%, and 21.5% of patients had T downstaging, no change, and upstaging, respectively. Comparatively, 3.5%, 53.4%, and 43.1% of patients who underwent upfront surgical resection were over-staged, accurately staged, and under-staged, respectively, in reference to the T stage. Adjusting for patient, hospital, treatment, tumor, and margin status covarities, a favorable response to NAT, or T downstaging, was significantly associated with higher OS (HR 0.80, 95% CI 0.75-0.86; median OS 34.4 months, 95% CI 32.6-36.5) compared with a non-favorable response to NAT as the reference group (median OS 27.9 months, 95% CI 26.9-28.8). Similarly, a favorable response to NAT in the N stage was associated with a higher OS (HR 0.87, 95% CI 0.79-0.95; median OS 33.7 months, 95% CI 31.4-36.5) compared with a non-favorable response (median OS 29.3 months, 95% CI 28.6-30.3). Conclusion A favorable response to NAT is associated with higher OS among PDAC patients who underwent curative intent surgery.
背景 胰腺导管腺癌（PDAC）新辅助治疗（NAT）后的完全病理缓解很少见；需要与生存相关的替代标志物。本研究的目的是评估肿瘤对NAT的反应对接受NAT和根治性手术的PDAC患者总生存期（OS）的影响。方法 一项回顾性研究利用2006 - 2018年国家癌症数据库确定了6960例接受NAT的成年PDAC患者。作为对照队列，对15799例接受 upfront 手术切除的患者进行了单独分析。接受NAT的患者的主要结局是根据病理T和N分期相对于NAT后的临床T和N分期的变化来评估OS，定义为良好反应（降期）和非良好反应（无变化和升期）。结果 NAT后，分别有35.1%、43.4%和21.5%的患者出现T降期、无变化和升期。相比之下，接受 upfront 手术切除的患者中，分别有3.5%、53.4%和43.1%的患者相对于T分期被过度分期、准确分期和分期不足。在调整患者、医院、治疗、肿瘤和切缘状态协变量后，与以对NAT的非良好反应为参照组相比，对NAT的良好反应或T降期与更高的OS显著相关（风险比0.80，95%置信区间0.75 - 0.86；中位OS 34.4个月，95%置信区间32.6 - 36.5）（中位OS 27.9个月，95%置信区间26.9 - 28.8）。同样地，与非良好反应相比，N分期对NAT的良好反应与更高的OS相关（风险比0.87，95%置信区间0.79 - 0.95；中位OS 33.7个月，95%置信区间31.4 - 36.5）（中位OS 29.3个月，95%置信区间28.6 - 30.3）。结论 对NAT的良好反应与接受根治性手术的PDAC患者更高的OS相关。
