Tailoring Adjuvant Chemotherapy to Biologic Response Following Neoadjuvant Chemotherapy Impacts Overall Survival in Pancreatic Cancer.
Tailoring Adjuvant Chemotherapy to Biologic Response Following Neoadjuvant Chemotherapy Impacts Overall Survival in Pancreatic Cancer.
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DOI：
10.1007/s11605-022-05476-w
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发表时间：
2023-04
影响因子：
3.2
通讯作者：
He, Jin
中科院分区：
文献类型：
--
作者：
Ghabi, Elie M.;Shoucair, Sami;Ding, Ding;Javed, Ammar A.;Thompson, Elizabeth D.;Zheng, Lei;Cameron, John L.;Wolfgang, Christopher L.;Shubert, Christopher R.;Lafaro, Kelly J.;Burkhart, Richard A.;Burns, William R.;He, Jin
术后化疗对于接受新辅助治疗的胰腺癌切除患者的作用尚不清楚。临床医生利用 CA19-9 和组织病理学评分的变化来评估治疗反应。我们试图调查 NAT 引起的 CA19-9 正常化是否有助于指导术后治疗的需要。对 2011 年至 2019 年间接受 NAT 后接受手术的基线 CA19-9 升高 (CA19-9 > 37U/mL) 的患者进行回顾性分析。治疗反应由 NAT 和组织病理学评分后的 CA19-9 正常化来确定。根据 CA19-9 正常化和组织病理学反应分析术后化疗的作用。我们确定并纳入了 345 名患者。 NAT 后，125 名患者 (36.2%) 观察到 CA19-9 正常化。 CA19-9 正常化与良好的组织病理学反应（41.6% vs 23.2%，p < 0.001）以及较低的 ypT（p < 0.001）和 ypN 分期（p = 0.003）相关。对于 NAT 后 CA19-9 未正常化的患者，接受辅助化疗与总生存期改善相关（26.8 个月与 16.4 个月，p = 0.008）。在接受基于 5FU 的 NAT 且 CA19-9 未正常化的患者中，接受基于 5FU 的辅助化疗与 OS 改善相关 (p = 0.014)。 CA19-9 对 NAT 的反应正常化与良好的结果相关，并且可以作为治疗反应的生物标志物。在 CA19-9 未正常化的患者中，接受术后化疗与 OS 改善相关。这些患者在基于 5FU 的 NAT 后还受益于额外的基于 5FU 的术后化疗。
The role of postoperative chemotherapy in patients with resected pancreatic cancer who receive neoadjuvant treatment is unknown. Clinicians use changes in CA19-9 and histopathologic scores to assess treatment response. We sought to investigate if CA19-9 normalization in response to NAT can help guide the need for postoperative treatment. Patients with elevated baseline CA19-9 (CA19-9 > 37U/mL) who received NAT followed by surgery between 2011 and 2019 were retrospectively reviewed. Treatment response was determined by CA19-9 normalization following NAT and histopathologic scoring. The role of postoperative chemotherapy was analyzed in light of CA19-9 normalization and histopathologic response. We identified and included 345 patients. Following NAT, CA19-9 normalization was observed in 125 patients (36.2%). CA19-9 normalization was associated with a favorable histopathologic response (41.6% vs 23.2%, p < 0.001) and a lower ypT (p < 0.001) and ypN stage (p = 0.003). Receipt of adjuvant chemotherapy was associated with improved overall survival in patients in whom CA19-9 did not normalize following NAT (26.8 vs 16.4 months, p = 0.008). In patients who received 5FU-based NAT and in whom CA19-9 did not normalize, receipt of 5FU-based adjuvant chemotherapy was associated with improved OS (p = 0.014). CA19-9 normalization in response to NAT was associated with favorable outcomes and can serve as a biomarker for treatment response. In patients where CA19-9 did not normalize, receipt of postoperative chemotherapy was associated with improved OS. These patients also benefited from additional 5FU-based postoperative chemotherapy following 5FU-based NAT.
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影响因子：
3.7
作者：
Katz MH;Varadhachary GR;Fleming JB;Wolff RA;Lee JE;Pisters PW;Vauthey JN;Abdalla EK;Sun CC;Wang H;Crane CH;Lee JH;Tamm EP;Abbruzzese JL;Evans DB
通讯作者：
Evans DB
影响因子：
28.2
作者：
Tiriac H;Belleau P;Engle DD;Plenker D;Deschênes A;Somerville TDD;Froeling FEM;Burkhart RA;Denroche RE;Jang GH;Miyabayashi K;Young CM;Patel H;Ma M;LaComb JF;Palmaira RLD;Javed AA;Huynh JC;Johnson M;Arora K;Robine N;Shah M;Sanghvi R;Goetz AB;Lowder CY;Martello L;Driehuis E;LeComte N;Askan G;Iacobuzio-Donahue CA;Clevers H;Wood LD;Hruban RH;Thompson E;Aguirre AJ;Wolpin BM;Sasson A;Kim J;Wu M;Bucobo JC;Allen P;Sejpal DV;Nealon W;Sullivan JD;Winter JM;Gimotty PA;Grem JL;DiMaio DJ;Buscaglia JM;Grandgenett PM;Brody JR;Hollingsworth MA;O'Kane GM;Notta F;Kim E;Crawford JM;Devoe C;Ocean A;Wolfgang CL;Yu KH;Li E;Vakoc CR;Hubert B;Fischer SE;Wilson JM;Moffitt R;Knox J;Krasnitz A;Gallinger S;Tuveson DA
通讯作者：
Tuveson DA
影响因子：
3.2
作者：
de Geus, Susanna W. L.;Kasumova, Gyulnara G.;Tseng, Jennifer F.
通讯作者：
Tseng, Jennifer F.
影响因子：
3.8
作者：
Maeda, Shimpei;Mederos, Michael A.;Donahue, Timothy R.
通讯作者：
Donahue, Timothy R.
影响因子：
3.7
作者：
Shoucair, Sami;Habib, Joseph R.;Yu, Jun
通讯作者：
Yu, Jun