Neoadjuvant therapy versus upfront surgery for early-stage left-sided pancreatic adenocarcinoma: A propensity-matched analysis from a national cohort of distal pancreatectomies
Neoadjuvant therapy versus upfront surgery for early-stage left-sided pancreatic adenocarcinoma: A propensity-matched analysis from a national cohort of distal pancreatectomies
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DOI：
10.1002/jso.26267
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发表时间：
2020-10-25
影响因子：
2.5
通讯作者：
Paniccia, Alessandro
中科院分区：
文献类型：
--
作者：
Nassour, Ibrahim;Adam, Mohamed A.;Paniccia, Alessandro
关于早期远端胰腺腺癌（PDAC）的新辅助治疗（NAT）的疗效的数据有限。以前的研究主要集中在胰腺头部的腺癌或处理身体和尾巴的交界性和局部晚期肿瘤。方法对2006 - 2015年国家癌症数据库进行回顾性研究。进行倾向匹配分析，比较NAT组和前期切除组（UR）之间的总生存估计。结果共发现5003例PDAC远端胰腺切除术，其中408例（9%）行NAT。经1:1匹配，NAT患者353例，UR患者353例。NAT与低90天死亡率相关。在淋巴结数量和住院时间上没有差异。通过匹配，NAT组的中位总生存期高于UR组（33.0个月vs 27.0个月；p = 0.009）和调整总生存期（风险比= 0.63,95%可信区间= 0.51-0.77;p < 0.001）。结论与UR相比，接受NAT后远端胰腺切除术治疗早期远端PDAC可提高总生存率。本研究支持在胰腺体和尾部早期腺癌的多模式治疗范式中使用NAT。
Background There are limited data on the efficacy of neoadjuvant therapy (NAT) for early-stage distal pancreas adenocarcinoma (PDAC). Previous studies focused on adenocarcinoma of the head of the pancreas or dealt with borderline and locally advanced tumors of the body and tail.Methods This is a retrospective study of the National Cancer Database between 2006 and 2015. A propensity-matched analysis was performed to compare overall survival estimates between NAT and upfront resection (UR) groups.Results A total of 5003 distal pancreatectomies for PDAC were identified, of whom 408 (9%) received NAT. After 1:1 matching, 353 NAT patients were compared with 353 UR patients. NAT was associated with lower 90-day mortality. There were no differences in the number of lymph nodes retrieved, or length of stay. With matching, the NAT group had higher median overall survival compared with UR (33.0 vs. 27.0 months; p = 0.009) and adjusted overall survival (hazard ratio = 0.63, 95% confidence interval = 0.51-0.77; p < 0.001).Conclusion The receipt of NAT followed by distal pancreatectomy for early-stage distal PDAC is associated with improved overall survival compared with UR. This study supports the use of NAT in the multimodal therapy paradigm of early-stage adenocarcinoma of the body and tail of the pancreas.