Margin negative resection and pathologic downstaging with multiagent chemotherapy with or without radiotherapy in patients with localized pancreas cancer: A national cancer database analysis.
Margin negative resection and pathologic downstaging with multiagent chemotherapy with or without radiotherapy in patients with localized pancreas cancer: A national cancer database analysis.
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局限性胰腺癌患者的切缘阴性切除和多药化疗加或不加放疗的病理降期：一项国家癌症数据库分析。
DOI：
10.1016/j.ctro.2020.12.003
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发表时间：
2021-03
影响因子：
3.1
通讯作者：
Jethwa KR
中科院分区：
文献类型：
--
作者：
Miccio JA;Talcott WJ;Patel T;Park HS;Cecchini M;Salem RR;Khan SA;Stein S;Kortmansky JS;Lacy J;Narang A;Herman J;Jabbour SK;Hallemeier CL;Johung K;Jethwa KR
完全切除是一种潜在的治愈胰腺癌的治疗方法。本报告研究了有或无放疗的新辅助化疗。放疗的增加与完全切除率的提高有关。放疗的增加与病理下分期的改善有关。边缘阴性（R0）切除是胰腺导管腺癌（PDAC）患者唯一可能治愈的治疗方法。术前单独多药化疗（MAC）或MAC后术前放疗（MAC + RT）可用于提高可切除性和潜在的生存。然而，最佳的术前方案尚不清楚。2006年至2016年在肿瘤切除前接受术前MAC或MAC + RT的非转移性PDAC患者被纳入国家癌症数据库。通过logistic回归确定与R0切除相关的单变量和多变量（MVA），并通过Kaplan Meier方法和Cox回归分析分析生存率。共发现4599例患者（MAC: 3109例，MAC + RT: 1490例）。接收MAC相比,患者接受MAC + RT更有可能有cT3-4疾病(76%比64%,p < 0.001)和cN +疾病(33%比29%,p = 0.010),但不太可能ypT3-4疾病(59%比74%,p < 0.001)和ypN +疾病(32%比55%,p < 0.001),更有可能有一个病理完全缓解(5%比2%,p < 0.001)和R0切除(86%比80%,p < 0.001)。在MVA、MAC + RT （OR 1.58, 95% CI 1.33 - 1.89, p < 0.001）、学术中心评估（OR 1.33, 95% CI 1.14-1.56, p < 0.001）和女性（OR 1.43, 95% CI 1.23-1.67, p < 0.001）与较高的R0切除几率相关，而cT3-4疾病（OR 0.81, 95% CI 0.68-0.96, p = 0.013）与较低的R0切除几率相关。对于术前接受MAC的局限性PDAC患者，术前RT的增加与R0切除术和病理反应的改善率相关。
Complete resection is a potentially curative treatment for pancreatic cancer. This report studies neoadjuvant chemotherapy with or without radiation. The addition of radiation was associated with improved complete resection rates. The addition of radiation was associated with improved pathologic down staging. Margin-negative (R0) resection is the only potentially curative treatment for patients with pancreatic ductal adenocarcinoma (PDAC). Pre-operative multi-agent chemotherapy alone (MAC) or MAC followed by pre-operative radiotherapy (MAC + RT) may be used to improve resectability and potentially survival. However, the optimal pre-operative regimen is unknown. Patients with non-metastatic PDAC from 2006 to 2016 who received pre-operative MAC or MAC + RT before oncologic resection were identified in the National Cancer Database. Univariable and multivariable (MVA) associates with R0 resection were identified with logistic regression, and survival was analyzed secondarily with the Kaplan Meier method and Cox regression analysis. 4,599 patients were identified (MAC: 3,109, MAC + RT: 1,490). Compared to those receiving MAC, patients receiving MAC + RT were more likely to have cT3-4 disease (76% vs 64%, p < 0.001) and cN + disease (33% vs 29%, p = 0.010), but were less likely to have ypT3-4 disease (59% vs 74%, p < 0.001) and ypN + disease (32% vs 55%, p < 0.001) and more likely to have a pathologic complete response (5% vs 2%, p < 0.001) and R0 resection (86% vs 80%, p < 0.001). On MVA, MAC + RT (OR 1.58, 95% CI 1.33–1.89, p < 0.001), evaluation at an academic center (OR 1.33, 95% CI 1.14–1.56, p < 0.001), and female sex (OR 1.43, 95% CI 1.23–1.67, p < 0.001) were associated with higher odds of R0 resection, while cT3-4 disease (OR 0.81, 95% CI 0.68–0.96, p = 0.013) was associated with lower odds of R0 resection. For patients with localized PDAC who receive pre-operative MAC, the addition of pre-operative RT was associated with improved rates of R0 resection and pathologic response.
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影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
45.3
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