Background:In patients with curatively resected pancreatic adenocarcinoma who have undergone neoadjuvant chemotherapy (NACT), evidence supporting the benefit of additional adjuvant chemotherapy (ACT) remains limited. We aim to identify favorable factors contributing to survival benefits in resected pancreatic adenocarcinoma after NACT.Methods: This is a retrospective cohort study of pancreatic adenocarcinoma patients who underwent NACT followed by curative surgical resection between 2008 and 2023 at a single academic institution. Univariate and multivariable analyses were conducted to identify factors contributing to disease-free survival (DFS) and overall survival (OS).Results: A total of 230 patients with a median age of 68 years (IQR, 62–72 years) were included. All patients underwent curative surgical resection. Of these, 42% received neoadjuvant modified (m) FOLFIRINOX (96/230), 15% received gemcitabine plus nab-paclitaxel (GEM-NAB) (34/230), and 43% received gemcitabine, docetaxel, and capecitabine (GTX) (100/230). In univariate analysis, lower College of American Pathologists (CAP) tumor regression grade (TRG) (0–1 vs. 2–3, median DFS: 29.8 vs. 14.2 months,p= 0.0081) and receipt of ACT (Yes vs. No, median DFS: 22.2 vs. 12.4 months,p< 0.0001) demonstrated significant associations with superior DFS. Multivariable analysis identified receipt of ACT as an independent predictor of superior DFS (HR 0.55, 95% CI: 0.39–0.78,p= 0.0007) and OS (HR 0.49, 95% CI: 0.33–0.71,p= 0.0002). However, the NACT regimen (mFOLFIRINOX vs. GEM-NAB) and the transition between neoadjuvant and adjuvant therapy (de-escalation vs. continuation vs. change) did not correlate with DFS or OS. The duration of perioperative chemotherapy showed a trend toward improved survival outcomes, though not statistically significant (6 months vs. <6 months: DFS, 19.4 vs. 16.2 months,p= 0.1448; OS, 49.6 vs. 30.4 months,p= 0.0623). In the following subgroup analyses, receipt of ACT provided DFS/OS benefits in patients who did not achieve a major pathologic response, pN0, or R0 resection (DFS:p= 0.0003; OS:p< 0.0001). However, it did not provide DFS/OS benefits in those who achieved a major pathologic response with pN0/R0 to NACT (DFS:p= 0.8036; OS:p= 0.1877).Conclusions: In resected pancreatic adenocarcinoma following NACT, receiving ACT was associated with favorable survival outcomes. Additional ACT appears to benefit patients who did not achieve a major pathologic response (pN0 or R0) to neoadjuvant therapy, with limited benefit for those who achieved a major response with pN0/R0. The specific NACT regimen (mFOLFIRINOX vs. GEM-NAB) and changes in ACT from NACT did not significantly influence survival outcomes in our cohort.
背景：对于接受新辅助化疗（NACT）后行根治性切除的胰腺腺癌患者，支持额外辅助化疗（ACT）获益的证据仍然有限。本研究旨在识别NACT后切除的胰腺腺癌患者中，有助于获得生存获益的有利因素。 方法：本研究为一项回顾性队列研究，纳入2008年至2023年间在一家学术机构接受NACT后行根治性手术切除的胰腺腺癌患者。通过单变量和多变量分析，识别与无病生存期（DFS）和总生存期（OS）相关的因素。 结果：共纳入230例患者，中位年龄68岁（四分位距，62-72岁）。所有患者均接受了根治性手术切除。其中，42%（96/230）接受了新辅助改良（m）FOLFIRINOX方案，15%（34/230）接受了吉西他滨联合白蛋白结合型紫杉醇（GEM-NAB）方案，43%（100/230）接受了吉西他滨、多西他赛和卡培他滨（GTX）方案。单变量分析显示，较低的美国病理学家学会（CAP）肿瘤退缩分级（TRG）（0-1级 vs. 2-3级，中位DFS：29.8个月 vs. 14.2个月，p=0.0081）以及接受ACT（是 vs. 否，中位DFS：22.2个月 vs. 12.4个月，p<0.0001）与更优的DFS显著相关。多变量分析确定接受ACT是更优DFS（HR 0.55，95% CI：0.39–0.78，p=0.0007）和OS（HR 0.49，95% CI：0.33–0.71，p=0.0002）的独立预测因子。然而，NACT方案（mFOLFIRINOX vs. GEM-NAB）以及新辅助与辅助治疗之间的转换（降阶梯 vs. 继续 vs. 更换）与DFS或OS无关。围手术期化疗时长显示出改善生存结局的趋势，但无统计学意义（6个月 vs. <6个月：DFS，19.4个月 vs. 16.2个月，p=0.1448；OS，49.6个月 vs. 30.4个月，p=0.0623）。在随后的亚组分析中，接受ACT为未达到主要病理缓解、pN0或R0切除的患者提供了DFS/OS获益（DFS：p=0.0003；OS：p<0.0001）。然而，对于达到主要病理缓解且pN0/R0的患者，接受ACT并未提供DFS/OS获益（DFS：p=0.8036；OS：p=0.1877）。 结论：在NACT后切除的胰腺腺癌中，接受ACT与良好的生存结局相关。额外的ACT似乎使未对新辅助治疗达到主要病理缓解（pN0或R0）的患者获益，而对于达到主要缓解且pN0/R0的患者获益有限。在本研究队列中，具体的NACT方案（mFOLFIRINOX vs. GEM-NAB）以及ACT相对于NACT的改变并未显著影响生存结局。
肿瘤(癌症)患者之家