James Yu, Jose M Laborde, Robin Park, Moazzam Shahzad, Youngchul Kim, Jaekyung Cheon, Iman Imanirad, Richard D Kim, Tiago Biachi de Castria, Nicole L Nardella, Mokenge Malafa, Jason W Denbo, Jason B Fleming, Sarah E Hoffe, Jessica M Frakes, Andrew J Sinnamon, Jose M Pimiento, Pamela J Hodul, Dae Won Kim
{"title":"胰腺导管腺癌切除术后新辅助治疗的病理反应和辅助化疗与生存的关系。","authors":"James Yu, Jose M Laborde, Robin Park, Moazzam Shahzad, Youngchul Kim, Jaekyung Cheon, Iman Imanirad, Richard D Kim, Tiago Biachi de Castria, Nicole L Nardella, Mokenge Malafa, Jason W Denbo, Jason B Fleming, Sarah E Hoffe, Jessica M Frakes, Andrew J Sinnamon, Jose M Pimiento, Pamela J Hodul, Dae Won Kim","doi":"10.3390/cancers17111797","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods</b>: 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). <b>Results</b>: 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, <i>p</i> = 0.0081) and receipt of ACT (Yes vs. No, median DFS: 22.2 vs. 12.4 months, <i>p</i> < 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, <i>p</i> = 0.0007) and OS (HR 0.49, 95% CI: 0.33-0.71, <i>p</i> = 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, <i>p</i> = 0.1448; OS, 49.6 vs. 30.4 months, <i>p</i> = 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: <i>p</i> = 0.0003; OS: <i>p</i> < 0.0001). However, it did not provide DFS/OS benefits in those who achieved a major pathologic response with pN0/R0 to NACT (DFS: <i>p</i> = 0.8036; OS: <i>p</i> = 0.1877). <b>Conclusions</b>: 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.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 11","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153592/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association of Pathologic Response and Adjuvant Chemotherapy with Survival in Resected Pancreatic Ductal Adenocarcinoma Following Neoadjuvant Therapy.\",\"authors\":\"James Yu, Jose M Laborde, Robin Park, Moazzam Shahzad, Youngchul Kim, Jaekyung Cheon, Iman Imanirad, Richard D Kim, Tiago Biachi de Castria, Nicole L Nardella, Mokenge Malafa, Jason W Denbo, Jason B Fleming, Sarah E Hoffe, Jessica M Frakes, Andrew J Sinnamon, Jose M Pimiento, Pamela J Hodul, Dae Won Kim\",\"doi\":\"10.3390/cancers17111797\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> 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. <b>Methods</b>: 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). <b>Results</b>: 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, <i>p</i> = 0.0081) and receipt of ACT (Yes vs. No, median DFS: 22.2 vs. 12.4 months, <i>p</i> < 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, <i>p</i> = 0.0007) and OS (HR 0.49, 95% CI: 0.33-0.71, <i>p</i> = 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, <i>p</i> = 0.1448; OS, 49.6 vs. 30.4 months, <i>p</i> = 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: <i>p</i> = 0.0003; OS: <i>p</i> < 0.0001). However, it did not provide DFS/OS benefits in those who achieved a major pathologic response with pN0/R0 to NACT (DFS: <i>p</i> = 0.8036; OS: <i>p</i> = 0.1877). <b>Conclusions</b>: 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.</p>\",\"PeriodicalId\":9681,\"journal\":{\"name\":\"Cancers\",\"volume\":\"17 11\",\"pages\":\"\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-05-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153592/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cancers\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3390/cancers17111797\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancers","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/cancers17111797","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:在接受新辅助化疗(NACT)的治愈性切除胰腺腺癌患者中,支持额外辅助化疗(ACT)的益处的证据仍然有限。我们的目标是确定有助于NACT术后胰腺腺癌切除患者生存获益的有利因素。方法:这是一项回顾性队列研究,研究对象是2008年至2023年间在一家学术机构接受NACT手术后进行根治性手术切除的胰腺腺癌患者。进行单变量和多变量分析,以确定影响无病生存期(DFS)和总生存期(OS)的因素。结果:共纳入230例患者,中位年龄68岁(IQR, 62-72岁)。所有患者均行根治性手术切除。其中,42%接受新辅助改良(m) FOLFIRINOX(96/230), 15%接受吉西他滨+ nab-紫杉醇(GEM-NAB)(34/230), 43%接受吉西他滨+多西他赛+卡培他滨(GTX)(100/230)。在单因素分析中,较低的美国病理学家学会(CAP)肿瘤消退等级(TRG) (0-1 vs. 2-3,中位DFS: 29.8 vs. 14.2个月,p = 0.0081)和接受ACT(是vs.否,中位DFS: 22.2 vs. 12.4个月,p < 0.0001)与较好的DFS有显著关联。多变量分析表明,接受ACT是较好的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)以及新辅助治疗和辅助治疗之间的过渡(缓解、继续和改变)与DFS或OS无关。围手术期化疗时间有改善生存结果的趋势,但没有统计学意义(6个月vs. p = 0.1448;OS: 49.6 vs 30.4个月,p = 0.0623)。在接下来的亚组分析中,对于未达到主要病理反应、pN0或R0切除的患者,接受ACT可提供DFS/OS益处(DFS: p = 0.0003;OS: p < 0.0001)。然而,对于那些pN0/R0达到NACT主要病理反应的患者,它并没有提供DFS/OS益处(DFS: p = 0.8036;OS: p = 0.1877)。结论:在NACT后切除的胰腺腺癌中,接受ACT与良好的生存结果相关。额外的ACT似乎对新辅助治疗没有达到主要病理反应(pN0或R0)的患者有益,对那些通过pN0/R0达到主要反应的患者有益有限。特定的NACT方案(mFOLFIRINOX vs. GEM-NAB)和NACT中ACT的变化对我们队列的生存结果没有显著影响。
Association of Pathologic Response and Adjuvant Chemotherapy with Survival in Resected Pancreatic Ductal Adenocarcinoma Following Neoadjuvant Therapy.
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.
期刊介绍:
Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.