Failure to Undergo Resection Following Neoadjuvant Therapy for Resectable Pancreatic Cancer: A Secondary Analysis of SWOG S1505.

IF 14.8 2区 医学 Q1 ONCOLOGY
Jordan M Cloyd, Sarah Colby, Katherine A Guthrie, Andy M Lowy, E Gabrielle Chiorean, Phillip Philip, Davendra Sohal, Syed Ahmad
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引用次数: 0

Abstract

Background: Neoadjuvant therapy (NT) is increasingly used for patients with pancreatic ductal adenocarcinoma (PDAC), and yet reasons for not undergoing subsequent pancreatectomy are poorly understood. Given the importance of completing multimodality therapy, we investigated factors associated with failure to undergo surgical resection following NT for PDAC.

Methods: SWOG S1505 was a multicenter phase II randomized trial of preoperative mFOLFIRINOX or gemcitabine/nab-paclitaxel prior to planned pancreatectomy for patients with potentially resectable PDAC. Associations between clinical, demographic, and hospital-level characteristics and receipt of surgical resection were estimated via multiple logistic regression. Differences in overall survival from 18 weeks postrandomization (scheduled time of surgery) according to resection status were assessed via Cox regression models.

Results: Among 102 eligible patients, 73 (71.6%) underwent successful pancreatectomy, whereas 29 (28.4%) did not, primarily because of progression (n=11; 10.8%) or toxicity during NT (n=9; 8.8%). Weight loss during NT (odds ratio [OR], 0.34; 95% CI, 0.11-0.93) and the hospital's city size (small: OR, 0.24 [95% CI, 0.07-0.80] and large: OR, 0.28 [95% CI, 0.10-0.79] compared with midsize) were significantly associated with a lower probability of surgical resection in adjusted models, whereas age, sex, race, body mass index, performance status, insurance type, geographic region, treatment arm, tumor location, chemotherapy delays/modifications, and hospital characteristics were not. Surgical resection following NT was associated with improved overall survival (median, 23.8 vs 10.8 months; P<.01) even after adjusting for grade 3-5 adverse events during NT, performance status, and body mass index (hazard ratio, 0.55; 95% CI, 0.32-0.95).

Conclusions: Failure to undergo resection following NT was relatively common among patients with potentially resectable PDAC and associated with worse survival. Although few predictive factors were identified in this secondary analysis of the SWOG S1505 randomized trial, further research must focus on risk factors for severe toxicities during NT that preclude surgical resection so that patient-centered interventions can be delivered or alternate treatment sequencing can be recommended.

可切除胰腺癌新辅助治疗后未能进行切除术:SWOG S1505 的二次分析。
背景:新辅助治疗(NT)越来越多地用于胰腺导管腺癌(PDAC)患者,但人们对其后未接受胰腺切除术的原因知之甚少。鉴于完成多模式治疗的重要性,我们研究了与PDAC NT治疗后未进行手术切除相关的因素:SWOG S1505 是一项多中心 II 期随机试验,针对潜在可切除的 PDAC 患者,在计划的胰腺切除术前进行术前 mFOLFIRINOX 或吉西他滨/纳布紫杉醇治疗。通过多元逻辑回归估算了临床、人口统计学和医院水平特征与接受手术切除之间的关系。通过 Cox 回归模型评估了随机化后 18 周(预定手术时间)总生存率的差异:在102名符合条件的患者中,73人(71.6%)成功接受了胰腺切除术,29人(28.4%)未接受胰腺切除术,主要原因是病情进展(11人;10.8%)或NT期间毒性(9人;8.8%)。NT期间体重减轻(几率比[OR],0.34;95% CI,0.11-0.93)和医院的城市规模(小:OR,0.24 [95% CI,0.07-0.80];大型医院:OR,0.28 [95% CI,0.07-0.93]:在调整模型中,与中型医院相比,小型医院的OR值为0.28 [95% CI, 0.10-0.79],而大型医院的OR值为0.28 [95% CI, 0.10-0.79])与较低的手术切除概率显著相关,而年龄、性别、种族、体重指数、表现状态、保险类型、地理区域、治疗臂、肿瘤位置、化疗延迟/修改和医院特征则不相关。NT术后手术切除与总生存期的改善有关(中位23.8个月 vs 10.8个月;PC结论:NT术后手术切除与总生存期的改善有关:在潜在可切除的PDAC患者中,NT后未能进行切除手术的情况相对常见,而且与生存率降低有关。虽然在这项SWOG S1505随机试验的二次分析中几乎没有发现预测因素,但进一步的研究必须关注NT期间出现严重毒性反应导致无法进行手术切除的风险因素,以便提供以患者为中心的干预措施或推荐替代治疗顺序。
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来源期刊
CiteScore
20.20
自引率
0.00%
发文量
388
审稿时长
4-8 weeks
期刊介绍: JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care. Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.
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