Predictors and survival for pathologic tumor response grade in borderline resectable and locally advanced pancreatic cancer treated with induction chemotherapy and neoadjuvant stereotactic body radiotherapy
Predictors and survival for pathologic tumor response grade in borderline resectable and locally advanced pancreatic cancer treated with induction chemotherapy and neoadjuvant stereotactic body radiotherapy
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DOI：
10.1080/0284186x.2016.1256497
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发表时间：
2017-01-01
期刊：
影响因子：
3.1
通讯作者：
Hoffe, Sarah E.
中科院分区：
文献类型：
--
作者：
Mellon, Eric A.;Jin, William H.;Hoffe, Sarah E.
背景：新辅助治疗反应与多种胃肠道恶性肿瘤的生存率相关。为了增加胰腺癌的新辅助治疗反应，我们在多药化疗后加强了立体定向体部放疗（SBRT）治疗。使用该方案，我们分析了胰腺切除术时美国病理学学院（CAP）肿瘤消退等级（TRG）是否与已建立的反应生物标志物和生存率相关。我们确定了根据我们的机构临床路径接受手术切除并报告TRG的边界可切除（BRPC）和局部晚期（LAPC）胰腺癌患者（n = 81，术后中位随访24.2个月）。患者有基线CA 19 -9、计算机断层扫描（CT）、内镜超声和FDG正电子发射断层扫描（PET）/CT，然后接受多药化疗（79%，3个周期的吉西他滨、多西他赛和卡培他滨），随后接受5次SBRT。然后他们接受了再分期CT、PET/CT和CA 19 -9。通过Kaplan-Meier和对数秩方法估计和比较总（OS）和无进展（PFS）生存期。单变量有序logistic回归分析显示TRG与基线、再分期、CA 19 - 9变化和PET最大标准摄取值（SUVmax）相关。
Background: Neoadjuvant therapy response correlates with survival in multiple gastrointestinal malignancies. To potentially augment neoadjuvant response for pancreas adenocarcinoma, we intensified treatment with stereotactic body radiotherapy (SBRT) following multi-agent chemotherapy. Using this regimen, we analyzed whether the College of American Pathology (CAP) tumor regression grade (TRG) at pancreatectomy correlated with established response biomarkers and survival.Materials and methods: We identified borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer patients treated according to our institutional clinical pathway who underwent surgical resection with reported TRG (n = 81, median follow-up after surgery 24.2 months). Patients had baseline CA19-9, computed tomography (CT), endoscopic ultrasound, and FDG positron emission tomography (PET)/CT then underwent multi-agent chemotherapy (79% with three cycles of gemcitabine, docetaxel and capecitabine) followed by 5-fraction SBRT. They then underwent restaging CT, PET/CT and CA19-9. Overall (OS) and progression-free (PFS) survival were estimated and compared by Kaplan-Meier and log-rank methods. Univariate ordinal logistic regression correlated TRG with baseline, restaging and change in CA19-9 and the PET maximum standardized uptake value (SUVmax).Results: Restaging level and decrease in CA19-9 correlated with improved TRG (p=.02 for both) as did restaging SUVmax (p