Neoadjuvant therapy is associated with a reduced lymph node ratio in patients with potentially resectable pancreatic cancer.
Neoadjuvant therapy is associated with a reduced lymph node ratio in patients with potentially resectable pancreatic cancer.
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DOI：
10.1245/s10434-014-4192-6
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发表时间：
2015-04
影响因子：
3.7
通讯作者：
Fleming JB
中科院分区：
文献类型：
--
作者：
Roland CL;Yang AD;Katz MH;Chatterjee D;Wang H;Lin H;Vauthey JN;Pisters PW;Varadhachary GR;Wolff RA;Crane CH;Lee JE;Fleming JB
使用新辅助治疗(NAC)治疗潜在的可切除胰腺癌仍然存在争议。在这项研究中，我们试图评估接受NAC和手术优先(SF)方法的患者的癌症特异性终点，其中特别强调淋巴转移。对1990年至2008年间接受NAC治疗的222名患者和接受SF治疗的85名患者进行鉴定，并对癌症相关终点进行比较。对135例新辅助治疗患者的胰腺周围淋巴结进行了组织学肿瘤消退评估。与SF方法相比，接受NAC后再手术的患者总体存活率和局部复发时间都有所改善。NAC患者较少有淋巴结转移(p=0.001)、淋巴血管侵犯(LVI)和较小的肿瘤。在多变量分析中，淋巴结阳性与SF、肿瘤大小和LVI的存在相关。患有N0疾病的NAC患者的预后与低LNR(0.01-0.15)的患者相同，而LNR>；0.15的患者存活率降低，局部和远处复发的时间缩短。10/135(7.4%)的NAC患者有至少1个淋巴结肿瘤消退的证据。选择接受NAC的潜在可切除PDAC的患者存活率提高，复发时间更长。尽管其中一些差异可能与多模式治疗完成率的提高有关，但淋巴转移的肿瘤消退是存在的，并可能表明与SF方法相比，NAC具有生物学上的好处。
The use of neoadjuvant therapy (NAC) for the treatment of potentially resectable pancreatic cancer remains controversial. In this study we sought to evaluate cancer-specific end-points in patients undergoing a NAC vs. a surgery-first (SF) approach with specific emphasis on lymph node metastases. Two hundred twenty two patients who underwent NAC and eighty-five patients who underwent SF were identified from 1990–2008 and compared for cancer-related end-points. Peripancreatic lymph nodes from one hundred thirty five neoadjuvant therapy patients were evaluated for histologic tumor regression. Patients who underwent NAC followed by surgery had improved overall survival and time to local recurrence compared to SF approach. NAC patients were less likely to have lymph node metastases (p=0.001), lymphovascular invasion (LVI) and had smaller tumors. On multivariate analysis, lymph node positivity was associated with SF, tumor size and the presence of LVI. NAC patient with N0 disease had equivalent outcomes to patients with a low-LNR (.01–0.15), while patients with a LNR >0.15 had reduced survival, and time to local and distant recurrence. 10/135 (7.4%) of NAC patients had evidence of tumor regression in at least 1 lymph node. Patients with potentially resectable PDAC selected to undergo NAC had improved survival and longer time to recurrence. Although some of these differences may be related to improvements in multimodality therapy completion rates, tumor regression in lymph node metastases exists and may demonstrate a biologic benefit of NAC compared to a SF approach.
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影响因子：
3.2
作者：
Valsangkar, Nakul P.;Bush, Devon M.;Michaelson, James S.;Ferrone, Cristina R.;Wargo, Jennifer A.;Lillemoe, Keith D.;Fernandez-del Castillo, Carlos;Warshaw, Andrew L.;Thayer, Sarah P.
通讯作者：
Thayer, Sarah P.
影响因子：
3.6
作者：
Embuscado, EE;Laheru, D;Iacobuzio-Donahue, CA
通讯作者：
Iacobuzio-Donahue, CA
影响因子：
45.3
作者：
Evans, Douglas B.;Varadhachary, Gauri R.;Wolff, Robert A.
通讯作者：
Wolff, Robert A.
影响因子：
3.2
作者：
Katz, Matthew H. G.;Wang, Huamin;Fleming, Jason B.
通讯作者：
Fleming, Jason B.
影响因子：
2.5
作者：
Sinn, Marianne;Striefler, Jana K.;Oettle, Helmut
通讯作者：
Oettle, Helmut