Kato Yoshiyasu, Ashida Ryo, Ohgi Katsuhisa, Otsuka Shimpei, Dei Hideyuki, Uesaka Katsuhiko, Yamazaki Kentaro, Sugiura Teiichi
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center.
Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Pancreas. 2025 Aug 1;54(7):e630-e636. doi: 10.1097/MPA.0000000000002485.
Neoadjuvant therapy (NAT) followed by surgery is becoming a standard treatment even for resectable pancreatic cancer (RPC). However, it is unclear whether NAT is necessary for all RPC cases.
A total of 296 patients diagnosed with RPC and under 80 years old were retrospectively analyzed, focusing on tumor markers (TMs). The cutoff value of TM was decided based on the classification by the International Association of Pancreatology.
Among 80 cases who underwent NAT, 72 cases accomplished surgical resection. Upfront surgery (UpS) was planned in 216 cases, and surgical resection was accomplished in 199 cases. Resection rate showed no difference between the two groups ( P = 0.638). Although NAT group showed a favorable trend in overall survival (OS) compared with the UpS group, the difference was not significant ( P = 0.143). carbohydrate antigen 19-9 >500 U/mL and/or duke pancreatic monoclonal antigen type 2 >700 U/mL was defined as high TM. When comparing in TM-high group (n = 83), patients with NAT showed significantly better OS than those without NAT ( P = 0.024). In TM-low group (n = 213), the OS curves completely overlapped with no difference ( P = 0.902). A multivariate analysis demonstrated that undergoing NAT was the sole independent prognostic factor in the TM-high group (hazard ratio: 0.48, P = 0.044) while undergoing NAT was not a prognostic factor in the TM-low group.
The efficacy of NAT for RPC might be limited to the subset of patients with high TM.
新辅助治疗（NAT）后行手术治疗正成为可切除胰腺癌（RPC）的标准治疗方法。然而，对于所有RPC病例是否都需要NAT尚不清楚。
回顾性分析了296例年龄在80岁以下、诊断为RPC的患者，重点关注肿瘤标志物（TMs）。TM的临界值根据国际胰腺病协会的分类确定。
在80例行NAT的患者中，72例完成了手术切除。216例计划行直接手术（UpS），199例完成了手术切除。两组的切除率无差异（P = 0.638）。虽然NAT组与UpS组相比总生存期（OS）有良好趋势，但差异不显著（P = 0.143）。糖类抗原19-9>500 U/mL和/或杜克胰腺单克隆抗原2型>700 U/mL被定义为高TM。在TM高组（n = 83）中进行比较时，接受NAT的患者的OS明显优于未接受NAT的患者（P = 0.024）。在TM低组（n = 213）中，OS曲线完全重叠，无差异（P = 0.902）。多因素分析表明，在TM高组中接受NAT是唯一的独立预后因素（风险比：0.48，P = 0.044），而在TM低组中接受NAT不是预后因素。
NAT对RPC的疗效可能仅限于TM高的患者亚组。
