Histological treatment response to neoadjuvant chemotherapy predicts the survival outcomes of patients with resectable pancreatic cancer: validation of the Japan Pancreas Society grading system.
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引用次数: 0
Abstract
Purpose: To validate the prognostic value of histological treatment response, assessed using the Japan Pancreas Society (JPS) grading system, in patients with resectable pancreatic ductal adenocarcinoma (PDAC) treated with neoadjuvant chemotherapy (NAC) followed by surgical resection.
Methods: We analyzed, retrospectively, data from 117 consecutive patients who underwent NAC and curative-intent PDAC resection at Tohoku University Hospital between January 2010 and December 2022. Histological responses were graded using the JPS system. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards modeling.
Results: Histological Grade 1a, 1b, 2, 3, and 4 responses were observed in 47 (40.2%), 42 (35.9%), 21 (17.9%), 6 (5.1%), and 1 (0.9%) patients, respectively. Patients with a Grade ≥ 2 response had significantly longer overall survival (OS) and significantly higher R0 resection rates than those with Grade 1a or 1b responses (median OS: 118.7 vs. 46.6 months, p = 0.037; 100% vs. 82.0%, p = 0.01). In a multivariable Cox regression model including RECIST progression status and baseline covariates, JPS Grade ≥ 2 remained significantly associated with better OS (adjusted HR 0.48; 95% CI 0.24-0.96; p = 0.039).
Conclusion: Substantial histological response (JPS Grade ≥ 2) after NAC is strongly associated with improved OS and higher R0 resection rates in patients with resectable PDAC. The JPS grading system provides a basis for clinically meaningful prognostic stratification.
目的：利用日本胰腺学会（JPS）分级系统评估可切除胰导管腺癌（PDAC）患者在接受新辅助化疗（NAC）后手术切除的组织学治疗反应，以验证其预后价值。方法：我们回顾性分析了2010年1月至2022年12月期间在东北大学医院接受NAC和治疗目的PDAC切除术的117例连续患者的数据。采用JPS系统对组织学反应进行分级。生存率分析采用Kaplan-Meier估计和Cox比例风险模型。结果：分别有47例（40.2%）、42例（35.9%）、21例（17.9%）、6例（5.1%）和1例（0.9%）患者出现组织学1a级、1b级、2级、3级和4级缓解。≥2级反应的患者比1a级或1b级反应的患者有更长的总生存期（OS）和更高的R0切除率（中位OS: 118.7 vs 46.6个月，p = 0.037; 100% vs 82.0%, p = 0.01）。在包括RECIST进展状态和基线协变量的多变量Cox回归模型中，JPS等级≥2仍然与较好的OS显著相关（调整后危险度0.48;95% CI 0.24-0.96; p = 0.039）。结论：在可切除的PDAC患者中，NAC后的实质性组织学反应（JPS分级≥2）与改善的OS和更高的R0切除率密切相关。JPS分级系统为临床有意义的预后分层提供了依据。
期刊介绍：
Surgery Today is the official journal of the Japan Surgical Society. The main purpose of the journal is to provide a place for the publication of high-quality papers documenting recent advances and new developments in all fields of surgery, both clinical and experimental. The journal welcomes original papers, review articles, and short communications, as well as short technical reports("How to do it").
The "How to do it" section will includes short articles on methods or techniques recommended for practical surgery. Papers submitted to the journal are reviewed by an international editorial board. Field of interest: All fields of surgery.
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