CA19-9 Normalization During Pre-operative Treatment Predicts Longer Survival for Patients with Locally Progressed Pancreatic Cancer.
CA19-9 Normalization During Pre-operative Treatment Predicts Longer Survival for Patients with Locally Progressed Pancreatic Cancer.
复制标题
DOI：
10.1007/s11605-016-3149-4
复制
发表时间：
2016-07
期刊：
影响因子：
--
通讯作者：
Donahue TR
中科院分区：
文献类型：
--
作者：
Williams JL;Kadera BE;Nguyen AH;Muthusamy VR;Wainberg ZA;Hines OJ;Reber HA;Donahue TR
对于交界性可切除(BR)或局部晚期(LA)胰腺导管腺癌(PDAC)患者，与广泛采用的2-4个月的术前治疗相比，我们机构倾向于在考虑手术切除之前进行更长的持续时间。使用这一独特的方法，这项研究的目的是确定与生存相关的术前变量。我们回顾了1992-2014年间接受手术切除的BR/LA PDAC患者的记录。经过中位6个月的术前治疗，109例BR/LA PDAC患者(BR 63例，LA 46例)接受了探查，93例(85.3%)接受了胰腺切除术。术前接受至少6个月治疗的患者的中位总生存期(OS)长于接受更少治疗的患者(52.8vs.32.1月，P=0.044)。多因素分析显示，术前治疗时间是影响患者生存的最重要因素(危险比为4.79，P=0.043)。然而，无论接受化疗6个月以上还是少于6个月，CA19-9正常者的OS相似(71.4vs.101.8个月，P=0.930)。术前CA19-9下降可指导BR/LA PDAC患者的治疗时间。我们支持6个月的治疗，但对于那些病情恢复正常的患者，可以考虑在较短的疗程后进行手术。
Compared to the widely-adopted 2–4 months of pre-operative therapy for patients with borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC), our institution tends to administer a longer duration before considering surgical resection. Using this unique approach, the aim of this study was to determine preoperative variables associated with survival. Records from patients with BR/LA PDAC who underwent attempt at surgical resection from 1992–2014 were reviewed. After a median duration of 6 months of pre-operative treatment, 109 patients with BR/LA PDAC (BR 63, LA 46) were explored; 93 (85.3%) underwent pancreatectomy. Those who received at least 6 months of pre-operative treatment had longer median overall survival (OS) than those who received less (52.8 vs. 32.1 months, P=0.044). On multivariate analysis, pre-operative treatment duration was the strongest predictor of survival (hazard ratio (HR) 4.79, P=0.043). However, OS was similar in those whose CA19-9 normalized regardless of whether they received more or less than 6 months of chemotherapy (71.4 vs. 101.8 months, P=0.930). Pre-operative CA19-9 decline can guide treatment duration in patients with BR/LA PDAC. We endorse 6 months of therapy except in those patients whose values normalize, where surgery can be considered after a shorter course.