Predictors for resectability and survival in locally advanced pancreatic cancer after gemcitabine-based neoadjuvant therapy
Predictors for resectability and survival in locally advanced pancreatic cancer after gemcitabine-based neoadjuvant therapy
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DOI：
10.1186/1471-2482-14-72
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发表时间：
2014-09-25
期刊：
影响因子：
1.9
通讯作者：
Shan, Yan-Shen
中科院分区：
文献类型：
--
作者：
Chao, Ying-Jui;Sy, Edgar D.;Shan, Yan-Shen
背景资料：方法：2003年5月至2009年12月，对41例经组织学证实的局部晚期胰腺癌（LAPC）患者行吉西他滨新辅助治疗（GBNAT），观察其可切除性和生存率。胰头癌17例，体癌18例，尾癌6例。根据RECIST标准评价治疗反应。手术探查是根据反应和明确的计划，肿瘤和腹腔动脉/上级肠系膜动脉。采用Kaplan-Meier分析和考克斯模型计算可切除率和生存率。结果：最终25例患者接受了化疗（CT），16例患者接受了同步化放疗（CRT）。CR 2例（CT组1例，CRT组1例），PR 19例（CT组10例，CRT组9例）。20例患者（48.8%）被评估为可手术切除，其中17例（41.5%）成功切除，切缘阳性率为17.6%，3例探查失败为胰头癌致密粘连。2例胰颈癌仅转为纤维化。手术干预的患者有显著的精算总生存率。肿瘤位置和GBNAT后CA 199 < 152是可切除性的预测因素。GBNAT后CA-199 < 152和GBNAT后CA-125 < 32.8是较长疾病无进展生存期的预测因子。GBNAT前CA-199 < 294、GBNAT后CA-125 < 32.8和术后CEA < 6是较长总生存期的预测因子。肿瘤位置和GBNAT后CA-199 < 152是可切除性的预测因子，而GBNAT前CA-199 < 294，GBNAT后CA-125 < 32.8，GBNAT后CA-199 < 152和术后CEA < 6是患有GBNAT的LAPC患者的生存预测因子。
Background: To evaluate the predictors for resectability and survival of patients with locally advanced pancreatic cancer (LAPC) treated with gemcitabine-based neoadjuvant therapy (GBNAT).Methods: Between May 2003 and Dec 2009, 41 tissue-proved LAPC were treated with GBNAT. The location of pancreatic cancer in the head, body and tail was 17, 18 and 6 patients respectively. The treatment response was evaluated by RECIST criteria. Surgical exploration was based on the response and the clear plan between tumor and celiac artery/superior mesentery artery. Kaplan-Meier analysis and Cox Model were used to calculate the resectability and survival rates.Results: Finally, 25 patients received chemotherapy (CT) and 16 patients received concurrent chemoradiation therapy (CRT). The response rate was 51% (21 patients), 2 CR (1 in CT and 1 in CRT) and 19 PR (10 in CT and 9 in CRT). 20 patients (48.8%) were assessed as surgically resectable, in which 17 (41.5%) underwent successful resection with a 17.6% positive-margin rate and 3 failed explorations were pancreatic head cancer for dense adhesion. Two pancreatic neck cancer turned fibrosis only. Patients with surgical intervention had significant actuarial overall survival. Tumor location and post-GBNAT CA199 < 152 were predictors for resectability. Post-GBNAT CA-199 < 152 and post-GBNAT CA-125 < 32.8 were predictors for longer disease progression-free survival. Pre-GBNAT CA-199 < 294, post-GBNAT CA-125 < 32.8, and post-op CEA < 6 were predictors for longer overall survival.Conclusion: Tumor location and post-GBNAT CA199 < 152 are predictors for resectability while pre-GBNAT CA-199 < 294, post-GBNAT CA-125 < 32.8, post-GBNAT CA-199 < 152 and post-op CEA < 6 are survival predictors in LAPC patients with GBNAT.