■术前化疗(放射)治疗越来越多地用于局限性胰腺腺癌患者,导致一小部分患者出现病理完全缓解(pCR)。然而,缺乏有关pCR的深入数据的多中心研究。
■为了调查发病率,结果,术前化疗(放疗)后pCR的危险因素。
■这个观测,国际,多中心队列研究评估了来自8个国家(2010年1月1日至2018年12月31日)的19个中心的所有连续病理证实的局限性胰腺腺癌患者,这些患者在2个或更多周期的化疗(有或没有放疗)后接受了切除治疗.数据收集时间为2020年2月1日至2022年4月30日,分析时间为2022年1月1日至2023年12月31日。中位随访时间为19个月。
■术前化疗(有或没有放疗),然后切除。
■pCR的发生率(定义为切除后取样的胰腺标本中没有重要的肿瘤细胞),它与手术中的OS相关联,以及与pCR相关的因素。使用Cox比例风险和logistic回归模型研究了与总生存期(OS)和pCR相关的因素,分别。
■总的来说,1758例患者(平均[SD]年龄,64[9]岁;879[50.0%]男性)进行了研究。pCR率为4.8%(n=85),pCR与OS相关(风险比,0.46;95%CI,0.26-0.83)。1-,3-,5年OS率为95%,82%,在pCR患者中,63%vs80%,46%,30%的患者没有pCR,分别(P<.001)。与pCR相关的因素包括除(m)FOLFIRINOX([修饰的]亚叶酸钙[亚叶酸],氟尿嘧啶,盐酸伊立替康,和奥沙利铂)(比值比[OR],0.48;95%CI,0.26-0.87),术前常规放疗(OR,2.03;95%CI,1.00-4.10),术前立体定向放射治疗(OR,8.91;95%CI,4.17-19.05),放射学反应(OR,13.00;95%CI,7.02-24.08),术前治疗后血清糖类抗原19-9正常(OR,3.76;95%CI,1.79-7.89)。
■这个国际,回顾性队列研究发现,术前化疗(放疗)治疗后,4.8%的局部胰腺腺癌切除患者发生pCR.虽然pCR不能反映治愈,它与改进的操作系统相关联,与无pCR患者的30%相比,5年OS翻了一番,达到63%。与pCR相关的术前化学(放射)治疗方案和解剖和生物学疾病反应特征相关的因素可能对需要在前瞻性研究中验证的治疗策略有影响,因为它们可能不适用于所有胰腺腺癌患者。
UNASSIGNED: Preoperative chemo(radio)therapy is increasingly used in patients with localized pancreatic adenocarcinoma, leading to pathological complete response (pCR) in a small subset of patients. However, multicenter studies with in-depth data about pCR are lacking.
UNASSIGNED: To investigate the incidence, outcome, and risk factors of pCR after preoperative chemo(radio)therapy.
UNASSIGNED: This observational, international, multicenter cohort study assessed all consecutive patients with pathology-proven localized pancreatic adenocarcinoma who underwent resection after 2 or more cycles of chemotherapy (with or without radiotherapy) in 19 centers from 8 countries (January 1, 2010, to December 31, 2018). Data collection was performed from February 1, 2020, to April 30, 2022, and analyses from January 1, 2022, to December 31, 2023. Median follow-up was 19 months.
UNASSIGNED: Preoperative chemotherapy (with or without radiotherapy) followed by resection.
UNASSIGNED: The incidence of pCR (defined as absence of vital tumor cells in the sampled pancreas specimen after resection), its association with OS from surgery, and factors associated with pCR. Factors associated with overall survival (OS) and pCR were investigated with Cox proportional hazards and logistic regression models, respectively.
UNASSIGNED: Overall, 1758 patients (mean [SD] age, 64 [9] years; 879 [50.0%] male) were studied. The rate of pCR was 4.8% (n = 85), and pCR was associated with OS (hazard ratio, 0.46; 95% CI, 0.26-0.83). The 1-, 3-, and 5-year OS rates were 95%, 82%, and 63% in patients with pCR vs 80%, 46%, and 30% in patients without pCR, respectively (P < .001). Factors associated with pCR included preoperative multiagent chemotherapy other than (m)FOLFIRINOX ([modified] leucovorin calcium [folinic acid], fluorouracil, irinotecan hydrochloride, and oxaliplatin) (odds ratio [OR], 0.48; 95% CI, 0.26-0.87), preoperative conventional radiotherapy (OR, 2.03; 95% CI, 1.00-4.10), preoperative stereotactic body radiotherapy (OR, 8.91; 95% CI, 4.17-19.05), radiologic response (OR, 13.00; 95% CI, 7.02-24.08), and normal(ized) serum carbohydrate antigen 19-9 after preoperative therapy (OR, 3.76; 95% CI, 1.79-7.89).
UNASSIGNED: This international, retrospective cohort study found that pCR occurred in 4.8% of patients with resected localized pancreatic adenocarcinoma after preoperative chemo(radio)therapy. Although pCR does not reflect cure, it is associated with improved OS, with a doubled 5-year OS of 63% compared with 30% in patients without pCR. Factors associated with pCR related to preoperative chemo(radio)therapy regimens and anatomical and biological disease response features may have implications for treatment strategies that require validation in prospective studies because they may not universally apply to all patients with pancreatic adenocarcinoma.