围手术期化疗对胰腺腺鳞癌患者的影响。
The impact of perioperative chemotherapy in patients with pancreatic adenosquamous carcinoma.
作者信息
Campbell Brady A, Habib Joseph R, Kinny-Köster Benedict, Purchla Julia, Franco Jorge Campos, Putri Aghnia J, Sahni Shristi, Hewitt D Brock, Sacks Greg D, Shubert Christopher R, Lafaro Kelly J, Burkhart Richard A, Burns William R, Thompson Elizabeth D, Kaiser Jörg, Javed Ammar A, Cameron John L, Loos Martin, Wolfgang Christopher L, Büchler Markus W, He Jin
机构信息
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: https://twitter.com/brady_campbell.
New York University Langone Health, Department of Surgery, New York, NY. Electronic address: https://twitter.com/j_habib1.
出版信息
Surgery. 2025 Aug 13;187:109611. doi: 10.1016/j.surg.2025.109611.
BACKGROUND
Pancreatic adenosquamous carcinoma has historically poor overall survival, and the impact of perioperative chemotherapy remains unclear. We aimed to evaluate the impact of various chemotherapy regimens in patients with resected adenosquamous carcinoma.
METHODS
Patients with resected adenosquamous carcinoma were identified from 3 high-volume programs between 2001 and 2022. We analyzed their clinicopathologic data and used Kaplan-Meier survival curves to assess the median overall survival and recurrence-free survival with 95% confidence intervals. Prognostic factors were assessed with a multivariable Cox-regression model adjusting for resectability status and Clavien-Dindo complications.
RESULTS
Among 168 patients, cohorts of neoadjuvant chemotherapy (41, 24%) and upfront surgery (127, 76%) showed similar demographics and TNM staging. The median overall survival was shorter in the neoadjuvant chemotherapy cohort compared with the upfront surgery cohort (13 vs 21 months, P = .133). Median overall survival by treatment approach was no chemotherapy (4 months), only neoadjuvant chemotherapy (8 months), only adjuvant therapy (24 months), and both neoadjuvant chemotherapy and adjuvant therapy (17 months). Recurrence-free survival data (69 patients) showed upfront surgery had significantly longer recurrence-free survival compared with neoadjuvant chemotherapy (18 months vs 5 months, P = .046). Multivariable analysis showed adjuvant therapy was associated with improved overall survival (hazard ratio, 0.27; P < .001), whereas age ≥65 (hazard ratio, 1.79, P = .030) was associated with worse overall survival.
CONCLUSION
The outcomes of resected adenosquamous carcinoma remain poor. Patients receiving neoadjuvant chemotherapy exhibited shorter recurrence-free survival and median overall survival, suggesting minimal benefit of neoadjuvant chemotherapy in treating this aggressive cancer. Meanwhile, adjuvant therapy appears to be protective but requires further investigation.
背景
胰腺腺鳞癌历来总体生存率较差，围手术期化疗的影响仍不明确。我们旨在评估各种化疗方案对接受手术切除的腺鳞癌患者的影响。
方法
从2001年至2022年期间的3个大型项目中识别出接受手术切除的腺鳞癌患者。我们分析了他们的临床病理数据，并使用Kaplan-Meier生存曲线评估中位总生存期和无复发生存期，并给出95%置信区间。使用多变量Cox回归模型评估预后因素，并对可切除状态和Clavien-Dindo并发症进行校正。
结果
在168例患者中，新辅助化疗组（41例，24%）和直接手术组（127例，76%）的人口统计学特征和TNM分期相似。与直接手术组相比，新辅助化疗组的中位总生存期较短（13个月对21个月，P = 0.133）。按治疗方法划分的中位总生存期分别为：未化疗（4个月）、仅新辅助化疗（8个月）、仅辅助治疗（24个月）以及新辅助化疗和辅助治疗均采用（17个月）。无复发生存期数据（69例患者）显示，与新辅助化疗相比，直接手术的无复发生存期明显更长（18个月对5个月，P = 0.046）。多变量分析显示，辅助治疗与总生存期改善相关（风险比，0.27；P < 0.001），而年龄≥65岁（风险比，1.79，P = 0.030）与总生存期较差相关。
结论
手术切除的腺鳞癌患者的预后仍然较差。接受新辅助化疗的患者无复发生存期和中位总生存期较短，这表明新辅助化疗在治疗这种侵袭性癌症方面益处不大。同时，辅助治疗似乎具有保护作用，但需要进一步研究。
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