接受当代新辅助化疗 (NAC) 的胰腺导管腺癌 (PDAC) 患者的放射学隐匿性转移性疾病 (ROMD) 尚未得到充分研究。本研究旨在分析接受 NAC 方法治疗 PDAC 的患者的发病率、危险因素和肿瘤学结果。一项回顾性审查分析了前瞻性维护的数据库，其中包含接受 NAC 治疗且在我们机构接受胰腺切除术的可能可切除 PDAC 的患者。 2011 年至 2022 年。进行多变量回归分析以评估与 ROMD 相关的风险因素。生成带有对数秩分析的 Kaplan-Meier 曲线来估计事件终点时间。该研究纳入了 366 名患者。该队列中 80% 的患者处于前期和临界可切除解剖分期，而 20% 的患者患有局部晚期疾病。最常见的 NAC 方案是 FOLFIRINOX（n = 274，75%）。对于 55 名携带 ROMD 的患者 (15%)，最常见的部位是仅肝脏转移 (n = 33, 60%)。 ROMD 的独立危险因素是 NAC 期间 CA19-9 水平升高（比值比 [OR]，7.01；置信区间 [CI]，1.97-24.96；p = 0.008）、不确定的肝脏病变（OR，2.19；CI，1.09-术前横断面成像显示主动脉旁淋巴结肿大（OR，6.87；CI，2.07-22.74；p = 0.002）。在时序分析中，接受姑息化疗（p < 0.001）和最终正式胰腺切除术（p = 0.04）与生存获益相关。 ROMD 患者的中位总生存期 (OS) 自初次诊断起接近 15 个月，中位 2 个月后出现转移的放射学证据。放射学隐匿性转移性疾病仍然是一个临床挑战，对于患有 ROMD 的患者来说，其预后不良。使用多剂 NAC 治疗 PDAC。© 2024。外科肿瘤学会。

Radiologic occult metastatic disease (ROMD) in patients with pancreatic ductal adenocarcinoma (PDAC) who undergo contemporary neoadjuvant chemotherapy (NAC) has not been well studied. This study sought to analyze the incidence, risk factors, and oncologic outcomes for patients who underwent the NAC approach for PDAC.A retrospective review analyzed a prospectively maintained database of patients who had potentially resectable PDAC treated with NAC and were offered pancreatectomy at our institution from 2011 to 2022. Multivariable regression analysis was performed to assess risk factors associated with ROMD. Kaplan-Meier curves with log-rank analyses were generated to estimate time-to-event end points.The study enrolled 366 patients. Upfront and borderline resectable anatomic staging comprised 80% of the cohort, whereas 20% had locally advanced disease. The most common NAC regimen was FOLFIRINOX (n = 274, 75%). For 55 patients (15%) who harbored ROMD, the most common site was liver-only metastases (n = 33, 60%). The independent risk factors for ROMD were increasing CA19-9 levels during NAC (odds ratio [OR], 7.01; confidence interval [CI], 1.97-24.96; p = 0.008), indeterminate liver lesions (OR, 2.19; CI, 1.09-4.39; p = 0.028), and enlarged para-aortic lymph nodes (OR, 6.87; CI, 2.07-22.74; p = 0.002) on preoperative cross-sectional imaging. Receipt of palliative chemotherapy (p < 0.001) and eventual formal pancreatectomy (p = 0.04) were associated with survival benefit in the log-rank analysis. The median overall survival (OS) of the patients with ROMD was nearly 15 months from the initial diagnosis, with radiologic evidence of metastases occurring after a median of 2 months.Radiologic occult metastatic disease remains a clinical challenge associated with poor outcomes for patients who have PDAC treated with multi-agent NAC.© 2024. Society of Surgical Oncology.