Impact of Neoadjuvant Therapy in Resected Pancreatic Ductal Adenocarcinoma of the Pancreatic Body or Tail on Surgical and Oncological Outcome: A Propensity-Score Matched Multicenter Study

被引：32

作者：

Lof, Sanne ^{[1
,2
]}

Korrel, Maarten ^{[2
]}

van Hilst, Jony ^{[2
,3
]}

Alseidi, Adnan ^{[4
]}

Balzano, Gianpaolo ^{[5
]}

Boggi, Ugo ^{[6
]}

Butturini, Giovanni ^{[7
]}

Casadei, Riccardo ^{[8
]}

Dokmak, Safi ^{[9
]}

Edwin, Bjorn ^{[10
,11
]}

Falconi, Massimo ^{[5
]}

Keck, Tobias ^{[12
]}

Malleo, Giuseppe ^{[13
]}

de Pastena, Matteo ^{[13
]}

Tomazic, Ales ^{[14
]}

Wilmink, Hanneke ^{[15
]}

Zerbi, Alessandro ^{[16
]}

Besselink, Marc G. ^{[2
]}

Abu Hilal, Mohammed ^{[1
,17
]}

Bonds, Morgan ^{[4
]}

Capretti, Giovanni ^{[16
]}

Fiorentini, Guido ^{[5
]}

Giardino, Alessandro ^{[7
]}

Lombardo, Carlo ^{[6
]}

Ricci, Claudio ^{[8
]}

机构：

[1] Southampton Univ Hosp NHS Fdn Trust, Dept Surg, Southampton, Hants, England

[2] Univ Amsterdam, Canc Ctr Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands

[3] OLVG, Dept Surg, Amsterdam, Netherlands

[4] Virginia Mason Med Ctr, Dept Surg, Seattle, WA 98101 USA

[5] Univ Vita Salute, San Raffaele Hosp IRCCS, Pancreat Surg, Milan, Italy

[6] Univ Pisa, Dept Surg, Pisa, Italy

[7] Pederzoli Hosp, Dept Surg, Peschiera, Italy

[8] St Orsola Marcello Malpighi Hosp, Dept Surg, Bologna, Italy

[9] Hosp Beaujon, Dept Surg, Clichy, France

[10] Oslo Univ Hosp, Dept Surg, Oslo, Norway

[11] Inst Clin Med, Oslo, Norway

[12] Clin Surg, UKSH Campus Lubeck, Lubeck, Germany

[13] Verona Univ Hosp, Pancreas Inst, Dept Surg, Verona, Italy

[14] Univ Med Ctr Ljubljana, Dept Surg, Ljubljana, Slovenia

[15] Univ Amsterdam, Canc Ctr Amsterdam, Dept Med Oncol, Amsterdam, Netherlands

[16] Humanitas Univ Hosp, Dept Surg, Milan, Italy

[17] Ist Osped Fdn Poliambulanza, Dept Gen Surg, Brescia, Italy

来源：

ANNALS OF SURGICAL ONCOLOGY | 2020年 / 27卷 / 06期

关键词：

INTERNATIONAL STUDY-GROUP; PREOPERATIVE CHEMORADIATION; POSTOPERATIVE-MORBIDITY; DISTAL PANCREATECTOMY; PROGNOSTIC-FACTOR; UPFRONT SURGERY; SPLENIC ARTERY; PORTAL-VEIN; CANCER; GEMCITABINE;

D O I：

10.1245/s10434-019-08137-6

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background Several studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head. Data concerning NAT for PDAC located in pancreatic body or tail are lacking. Methods Post hoc analysis of an international multicenter retrospective cohort of distal pancreatectomy for PDAC in 34 centers from 11 countries (2007-2015). Patients who underwent resection after NAT were matched (1:1 ratio), using propensity scores based on baseline characteristics, to patients who underwent upfront resection. Median overall survival was compared using the stratified log-rank test. Results Among 1236 patients, 136 (11.0%) received NAT, most frequently FOLFIRINOX (25.7%). In total, 94 patients receiving NAT were matched to 94 patients undergoing upfront resection. NAT was associated with less postoperative major morbidity (Clavien-Dindo >= 3a, 10.6% vs. 23.4%, P = 0.020) and pancreatic fistula grade B/C (9.6% vs. 21.3%, P = 0.026). NAT did not improve overall survival [27 (95% CI 14-39) versus 31 months (95% CI 19-42), P = 0.277], as compared with upfront resection. In a sensitivity analysis of 251 patients with radiographic tumor involvement of splenic vessels, NAT (n = 37, 14.7%) was associated with prolonged overall survival [36 (95% CI 18-53) versus 20 months (95% CI 15-24), P = 0.049], as compared with upfront resection. Conclusion In this international multicenter cohort study, NAT for resected PDAC in pancreatic body or tail was associated with less morbidity and pancreatic fistula but similar overall survival in comparison with upfront resection. Prospective studies should confirm a survival benefit of NAT in patients with PDAC and splenic vessel involvement.

引用

页码：1986 / 1996

页数：11