Is Neoadjuvant Therapy Sufficient in Resected Pancreatic Cancer Patients? A National Study
Is Neoadjuvant Therapy Sufficient in Resected Pancreatic Cancer Patients? A National Study
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DOI：
10.1007/s11605-017-3541-8
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发表时间：
2018-02-01
影响因子：
3.2
通讯作者：
Tseng, Jennifer F.
中科院分区：
文献类型：
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作者：
de Geus, Susanna W. L.;Kasumova, Gyulnara G.;Tseng, Jennifer F.
尽管新辅助治疗的使用越来越多，但术前治疗成功切除的患者是否应接受额外的术后辅助治疗的问题仍然没有答案。我们在一项大型国家研究中评估了胰腺癌患者新辅助治疗和胰腺切除术后辅助治疗的影响，我们使用了2006年至2013年的国家癌症数据库，以确定切除的非转移性胰腺癌患者接受新辅助化疗（放疗）治疗后进行胰腺切除术。Kaplan-Meier和多变量考克斯比例风险回归分析比较两组间的生存率，共确定了1357例患者。38.6%（n = 524）的患者接受了术后治疗。接受和未接受术后治疗的患者之间未校正的中位总生存期无差异（中位生存期，27.5 vs. 27.1个月，对数秩p = 0.5409）。术后治疗与切缘阳性（对数秩p = 0.6452）或淋巴结阳性（对数秩p = 0.6252）患者的良好预后无显著相关性。在多变量分析中，接受术后治疗不能预测生存率（风险比0.972; 95%CI 0.848-1.115; p = 0.6876）。我们使用国家数据的结果表明，接受新辅助治疗和胰腺切除术后，额外的术后治疗可能不会提供额外的生存获益。这些数据保证了进一步的前瞻性数据收集和临床试验的考虑。
Despite the increasing use of neoadjuvant treatment, the question of whether preoperatively treated, successfully resected patients should receive additional postoperative adjuvant treatment remains unanswered. We evaluate the impact of adjuvant therapy following neoadjuvant treatment and pancreatectomy in pancreatic cancer patients in a large national study.We used the National Cancer Data Base between 2006 and 2013 to identify resected, non-metastatic pancreatic adenocarcinoma patients who received neoadjuvant chemo(radio)therapy followed by pancreatectomy. Kaplan-Meier and multivariate Cox proportional hazard regression analyses were performed to compare survival between groups.In total, 1357 patients were identified. Of the patients, 38.6% (n = 524) were treated with postoperative therapy. There was no difference in unadjusted median overall survival between patients who did and did not receive postoperative therapy (median survival, 27.5 vs. 27.1 months, log-rank p = 0.5409). Postoperative therapy was not significantly associated with favorable prognosis in patients with positive resection margins (log-rank p = 0.6452) or positive lymph nodes (log-rank p = 0.6252). On multivariate analysis, receipt of postoperative therapy was not predictive of survival (hazard ratio 0.972; 95% CI 0.848-1.115; p = 0.6876).Our results using national data suggest that after receipt of neoadjuvant therapy and pancreatectomy, additional postoperative therapy may not provide additional survival benefit. These data warrant further prospective data collection and consideration for clinical trials.