新辅助化疗联合切除术治疗交界可切除和局部进展期胰腺癌的辅助化疗评价。
An evaluation of adjuvant chemotherapy following neoadjuvant chemotherapy and resection for borderline resectable and locally advanced pancreatic cancer.
机构信息
Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA.
出版信息
Am J Surg. 2022 Jul;224(1 Pt A):51-57. doi: 10.1016/j.amjsurg.2021.12.018. Epub 2021 Dec 28.
BACKGROUND
In borderline resectable and locally advanced (BRLA) pancreatic cancer patients, the role of adjuvant therapy (AT) after neoadjuvant therapy (NAT) and curative-intent resection is poorly understood.
METHODS
Using the National Cancer Database (NCDB) between 2011 and 2017, we identified BRLA patients who received NAT and resection. Kaplan-Meier analysis and multivariable Cox proportional hazards (PH) regression were performed to examine the association between AT and overall survival (OS).
RESULTS
Of 17,905 BRLA patients identified, 764 received NAT and resection, of which 203 received AT. Median age was 63 years, and 53.1% were female. Kaplan Meier analysis revealed no differences in median OS between AT vs non-AT groups (28.9 vs 30.1months, p = 0.498). In the multivariable Cox PH model, after adjusting for other factors, when margin was positive, AT was associated with an improved survival (HR 0.54, 95%CI 0.32-0.90, p = 0.031).
CONCLUSION
AT was not associated with survival in BRLA patients who received NAT and resection except in patients with positive margins. Further research is necessary to better understand the role of AT following NAT in patients with BRLA.
背景
在可切除边界和局部进展期（BRLA）胰腺癌患者中，新辅助治疗（NAT）后辅助治疗（AT）和根治性切除的作用知之甚少。
方法
使用 2011 年至 2017 年的国家癌症数据库（NCDB），我们鉴定了接受 NAT 和切除术的 BRLA 患者。通过 Kaplan-Meier 分析和多变量 Cox 比例风险（PH）回归来检查 AT 与总生存期（OS）之间的关联。
结果
在 17905 例 BRLA 患者中，764 例接受了 NAT 和切除术，其中 203 例接受了 AT。中位年龄为 63 岁，53.1%为女性。Kaplan-Meier 分析显示，AT 组与非 AT 组的中位 OS 无差异（28.9 与 30.1 个月，p=0.498）。在多变量 Cox PH 模型中，在调整其他因素后，当切缘阳性时，AT 与生存改善相关（HR 0.54，95%CI 0.32-0.90，p=0.031）。
结论
除了切缘阳性的患者外，NAT 后接受 AT 的 BRLA 患者的生存与 AT 无关。需要进一步研究以更好地了解在 BRLA 患者中，NAT 后 AT 的作用。
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