Optimal timing of surgery after neoadjuvant treatment in borderline resectable pancreatic cancer

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2024-07-21 DOI:10.1002/jhbp.12049
Hye-Sol Jung, Wooil Kwon, Won-Gun Yun, Woo Hyun Paik, Sang Hyub Lee, Ji Kon Ryu, Do-Youn Oh, Kyoung Bun Lee, Eui Kyu Chie, Jin-Young Jang
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Abstract

Background

Neoadjuvant treatment (NAT) is standard for borderline resectable pancreatic cancer (BRPC). However, consensus is lacking on the optimal surgical timing for patients with BRPC undergoing NAT. The aim of this study was to investigate the long-term outcomes of patients undergoing NAT for BRPC and suggest optimal resection timing.

Methods

Prospectively collected data for 282 patients with BRPC between January 2007 and December 2019 were retrospectively reviewed. There were 164 patients who underwent NAT followed by surgery, 45 for chemotherapy only, and 73 for upfront surgery. Among them, 150 patients who underwent R0 or R1 resection following NAT were investigated to identify prognostic factors.

Results

Patients receiving NAT followed by surgery showed the best survival (median overall survival [OS]; NAT followed by surgery vs. upfront surgery vs. chemotherapy only; 35 vs. 23 vs. 16 months). In the NAT group, 54 (36.0%) patients received less than 3 months of NAT, 68 (45.3%) received ≥3, <6 months, and 28 (18.7%) received longer than 6 months. Patients receiving ≥3 months of NAT showed an improved OS compared to <3 months (median; not reached vs. 27 months). In the FOLFIRINOX group, patients who received more than eight FOLFIRINOX cycles showed a good prognosis (<6 vs. 6–7 vs. ≥8 cycles; median survival, 26 vs. 41 months vs. not-reached). However, >12 cycles did not carry a survival benefit compared to 8–11 cycles.

Conclusion

The optimal resection timing following NAT is once a patient undergoes at least 3 months of neoadjuvant chemotherapy or at least eight FOLFIRINOX cycles.

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边缘可切除胰腺癌新辅助治疗后的最佳手术时机。
背景:新辅助治疗(NAT)是边缘可切除胰腺癌(BRPC)的标准治疗方法。然而,对于接受 NAT 的 BRPC 患者的最佳手术时机,目前还缺乏共识。本研究旨在调查接受 NAT 治疗的 BRPC 患者的长期疗效,并提出最佳切除时机的建议:回顾性审查了 2007 年 1 月至 2019 年 12 月期间收集的 282 例 BRPC 患者的前瞻性数据。接受 NAT 后再手术的患者有 164 人,仅接受化疗的患者有 45 人,先行手术的患者有 73 人。其中,150名患者在接受NAT后进行了R0或R1切除术,研究人员对这些患者进行了调查,以确定预后因素:结果:接受 NAT 后手术的患者生存率最高(中位总生存期 [OS];NAT 后手术 vs. 前置手术 vs. 仅化疗;35 个月 vs. 23 个月 vs. 16 个月)。在NAT组中,54例(36.0%)患者接受了少于3个月的NAT治疗,68例(45.3%)接受了≥3个月的NAT治疗,与8-11个周期的NAT治疗相比,12个周期的NAT治疗并没有带来生存获益:结论:NAT后的最佳切除时机是患者接受至少3个月的新辅助化疗或至少8个FOLFIRINOX周期后。
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来源期刊
Journal of Hepato‐Biliary‐Pancreatic Sciences
Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY
自引率
10.00%
发文量
178
审稿时长
6-12 weeks
期刊介绍: The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.
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