Preceding Systemic Chemotherapy for Patients with Pancreatic Ductal Adenocarcinoma with Positive Peritoneal Cytology Provides Survival Benefit Compared with Up-Front Surgery
Preceding Systemic Chemotherapy for Patients with Pancreatic Ductal Adenocarcinoma with Positive Peritoneal Cytology Provides Survival Benefit Compared with Up-Front Surgery
复制标题
DOI：
10.1245/s10434-021-09718-0
复制
发表时间：
2021-02-20
影响因子：
3.7
通讯作者：
Unno, Michiaki
中科院分区：
文献类型：
--
作者：
Ariake, Kyohei;Mizuma, Masamichi;Unno, Michiaki
背景对于腹膜细胞学（PPC）阳性的胰腺导管腺癌（PDAC）手术切除的意义存在争议。本研究旨在评估既往化疗是否对伴有PPC的PDAC患者有益。方法回顾性分析2017 - 2019年我院收治的34例无远处转移的原发性胰腺癌患者的临床资料。23例患者未接受新辅助治疗（NAT），11例接受NAT。所有患者在确诊PPC后接受全身化疗，如果PPC转为阴性，则接受手术切除。对治疗过程、中转手术率及预后进行评价。此外，将2003年至2016年期间接受未经NAT的前期手术的PPC患者的预后作为比较队列进行分析。结果未行NAT者中位生存期为31.4个月。52.2%的患者进行了CS。接受CS的患者比未接受CS的患者有更好的预后（p = 0.005）。可切除PDAC的CS率（78.5%）显著高于临界/不可切除PDAC（11.1%）（p = 0.002）。与前期手术相比，既往化疗可改善可切除PDAC患者的预后（MST 13.0个月; p = 0.016）。NAT后，CS率较低（27.3%），MST仅为14.1个月。结论化疗作为PDAC合并PPC的初始治疗，预后良好。特别是，可切除的PDAC与更大的改善预后的机会相关。未来的研究需要确定是否应该对这些患者进行前期手术或前期化疗。
Background The significance of surgical resection in pancreatic ductal adenocarcinoma (PDAC) with positive peritoneal cytology (PPC) is controversial. This study aimed to evaluate whether preceding chemotherapy could be beneficial for patients with PDAC with PPC. Methods Between 2017 and 2019, 34 consecutive PDAC patients diagnosed with PPC without distant metastasis were retrospectively reviewed. Twenty-three patients did not receive neoadjuvant treatment (NAT) and 11 received NAT. All patients received systemic chemotherapy after PPC was confirmed, and they underwent surgical resection if PPC turned negative. The treatment course, ratio of conversion surgery (CS), and prognosis were evaluated. Moreover, the prognosis of PPC patients who underwent up-front surgery without NAT between 2003 and 2016 was analyzed as a comparative cohort. Results The median survival time (MST) of the patients without NAT was 31.4 months. CS was performed in 52.2% of the patients. Patients who underwent CS had better prognoses than those who did not undergo CS (p = 0.005). The CS rate was significantly higher in resectable PDAC (78.5%) than in borderline/unresectable PDAC (11.1%) (p = 0.002). The prognosis of patients with resectable PDAC was improved with preceding chemotherapy compared with up-front surgery (MST 13.0 months; p = 0.016). After NAT, the CS rate was low (27.3%), and the MST was only 14.1 months. Conclusions As an initial treatment for PDAC patients with PPC, chemotherapy may lead to a favorable prognosis. Especially, resectable PDAC is associated with a greater chance of improved prognosis. Future studies are required to ascertain whether up-front surgery or preceding chemotherapy should be performed for these patients.