Introduction: Neoadjuvant treatment (NAT) for borderline (BD) or locally advanced (LA) primary pancreatic cancer (PDAC) is now a widely adopted approach. We present a case series of patients who have achieved a complete pathological response of the primary tumour on final histology following neoadjuvant chemotherapy +/− chemoradiation and radical surgery. Methods: Patients who underwent radical pancreatic resection following neoadjuvant treatment between March 2006 and March 2023 at a single institution were identified by retrospective case note review of a prospectively maintained database. Results: Ten patients were identified to have a complete primary pathological response (ypT0) on postoperative histology. Before treatment, five patients were considered BD and five were LA according to National Comprehensive Cancer Network guidelines. All patients underwent staging Computed Tomography (CT) and nine underwent18Fluorodeoxyglucose Positron Emission Tomography (18FDG-PET/CT) imaging, with a mean maximum standardized uptake value (SUVmax) of the primary lesion at 6.14 ± 1.98 units. All patients received neoadjuvant chemotherapy, and eight received further chemoradiotherapy prior to resection. Mean pre- and post-neoadjuvant treatment serum Ca19-9 was 148.0 ± 146.3 IU/L and 18.0 ± 18.7 IU/L, respectively (p= 0.01). The mean duration of NAT was 5.6 ± 1.7 months. The mean time from completion of NAT to surgery was 13.1 ± 8.3 weeks. The mean lymph node yield was 21.1 ± 10.4 nodes, with one patient found to have 1 lymph node involved. All resections were reported to be R0. The mean length of stay was 11.8 ± 6.2 days. At the time of analysis, one death was reported at 35 months postoperatively. Two cases of recurrence were reported at 16 months (surgical bed) and 33 months (pulmonary). All other patients remain alive and under active surveillance. The current overall survival is 26.6 ± 20.7 months and counting. Conclusions: Complete primary pathological response is uncommon but possible following neoadjuvant treatment in patients with PDAC. Further work to identify the common denominator within this unique cohort may lead to advances in the therapeutic approach and offer hope for patients diagnosed with borderline or locally advanced pancreatic ductal adenocarcinoma.
引言：对于临界性（BD）或局部晚期（LA）原发性胰腺癌（PDAC），新辅助治疗（NAT）现已成为广泛采用的治疗策略。本文报告一组病例，这些患者在经过新辅助化疗联合或不联合放化疗及根治性手术后，最终病理学检查显示原发肿瘤达到完全病理缓解。方法：通过回顾性分析前瞻性维护数据库中2006年3月至2023年3月期间在同一机构接受新辅助治疗后行根治性胰腺切除术的患者资料。结果：共发现10例患者术后病理显示原发灶达到完全病理缓解（ypT0）。根据美国国家综合癌症网络指南，治疗前5例患者被判定为临界性，5例为局部晚期。所有患者均接受分期计算机断层扫描（CT），其中9例接受18氟脱氧葡萄糖正电子发射断层扫描（18FDG-PET/CT），原发灶平均最大标准化摄取值（SUVmax）为6.14±1.98单位。所有患者均接受新辅助化疗，其中8例在切除前进一步接受放化疗。新辅助治疗前后血清Ca19-9平均水平分别为148.0±146.3 IU/L和18.0±18.7 IU/L（p=0.01）。新辅助治疗平均持续时间为5.6±1.7个月。从完成新辅助治疗到手术的平均间隔为13.1±8.3周。平均淋巴结检出数量为21.1±10.4枚，其中1例患者发现1枚淋巴结转移。所有切除均报告为R0切除。平均住院时间为11.8±6.2天。截至分析时，1例患者于术后35个月死亡，2例分别在术后16个月（手术床）和33个月（肺部）出现复发。其余患者均存活并处于积极随访中。当前总生存期为26.6±20.7个月且持续随访中。结论：胰腺导管腺癌患者在新辅助治疗后获得原发灶完全病理缓解虽不常见但确有可能。针对这一特殊群体的共同特征开展进一步研究，可能推动治疗策略的进步，为诊断为临界性或局部晚期胰腺导管腺癌的患者带来希望。
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