针对所有四种非胰腺壶腹周围癌的定制辅助化疗之路：一项国际多方法队列研究。
The road to tailored adjuvant chemotherapy for all four non-pancreatic periampullary cancers: An international multimethod cohort study.
发表日期：2024 May 28
作者：
Bas A Uijterwijk, Daniël H Lemmers, Michele Ghidini, Johanna W Wilmink, Alberto Zaniboni, Giuseppe Kito Fusai, Alessandro Zerbi, Bas Groot Koerkamp, Misha Luyer, Poya Ghorbani, Roberto Salvia, Steven White, Benedetto Ielpo, Brian K P Goh, Ugo Boggi, Geert Kazemier, Michael G House, Vasileios K Mavroeidis, Bergthor Björnsson, Michele Mazzola, Mario Serradilla, Dimitris Korkolis, Adnan Alseidi, Keith J Roberts, Zahir Soonawalla, Patrick Pessaux, William E Fisher, Sharnice Koek, Tara S Kent, Miljana Vladimirov, Louisa Bolm, Nigel Jamieson, Raffaele Dalla Valle, Jorg Kleeff, Alessandro Mazzotta, Miguel Angel Suarez Muñoz, Santiago Sánchez Cabús, Chad G Ball, Adam C Berger, Clarissa Ferarri, Marc G Besselink, Mohammed Abu Hilal,
来源：
BRITISH JOURNAL OF CANCER
摘要：
尽管十二指肠腺癌 (DAC)、肠壶腹腺癌 (AmpIT) 和胰胆管癌 (AmpPB) 亚型以及远端胆管癌 (dCCA) 之间的肿瘤行为和特征存在差异，但辅助化疗 (ACT) 对这些癌症的影响以及最佳的 ACT 方案尚未得到全面评估。本研究旨在评估定制 ACT 对 DAC、dCCA、AmpIT 和 AmpPB 的影响。2010 年至 2021 年间，从 36 个三级中心识别并收集了因非胰腺壶腹周围腺癌接受胰十二指肠切除术后的患者。根据非胰腺壶腹周围肿瘤类型，比较辅助化疗的效果以及辅助化疗的主要相关方案。主要结局是总生存期 (OS)。该研究总共包括 2866 名 DAC (n = 330)、AmpIT (n = 765)、AmpPB (n = 819) 和 dCCA (n = 952) 患者。其中，1329人获得ACT，1537人未获得ACT。 ACT 与 AmpPB (P = 0.004) 和 dCCA (P < 0.001) 的 OS 显着改善相关。此外，对于 dCCA 患者，与吉西他滨 (P = 0.004) 和吉西他滨 - 顺铂 (P = 0.001) 相比，卡培他滨单 ACT 提供了最大的 OS 获益。对于 AmpPB 患者，没有发现更优越的 ACT 方案（P > 0.226）。 ACT 与 DAC 和 AmpIT 的 OS 改善无关（分别为 P = 0.113 和 P = 0.445）。切除 AmpPB 和 dCCA 的患者似乎受益于 ACT。虽然 AmpPB 的最佳 ACT 仍未确定，但 dCCA 似乎对卡培他滨单一疗法显示出最有利的反应。量身定制的辅助治疗对于增强所有四种非胰腺壶腹周围腺癌的预后至关重要。© 2024。作者，获得 Springer Nature Limited 的独家许可。
Despite differences in tumour behaviour and characteristics between duodenal adenocarcinoma (DAC), the intestinal (AmpIT) and pancreatobiliary (AmpPB) subtype of ampullary adenocarcinoma and distal cholangiocarcinoma (dCCA), the effect of adjuvant chemotherapy (ACT) on these cancers, as well as the optimal ACT regimen, has not been comprehensively assessed. This study aims to assess the influence of tailored ACT on DAC, dCCA, AmpIT, and AmpPB.Patients after pancreatoduodenectomy for non-pancreatic periampullary adenocarcinoma were identified and collected from 36 tertiary centres between 2010 - 2021. Per non-pancreatic periampullary tumour type, the effect of adjuvant chemotherapy and the main relevant regimens of adjuvant chemotherapy were compared. The primary outcome was overall survival (OS).The study included a total of 2866 patients with DAC (n = 330), AmpIT (n = 765), AmpPB (n = 819), and dCCA (n = 952). Among them, 1329 received ACT, and 1537 did not. ACT was associated with significant improvement in OS for AmpPB (P = 0.004) and dCCA (P < 0.001). Moreover, for patients with dCCA, capecitabine mono ACT provided the greatest OS benefit compared to gemcitabine (P = 0.004) and gemcitabine - cisplatin (P = 0.001). For patients with AmpPB, no superior ACT regime was found (P > 0.226). ACT was not associated with improved OS for DAC and AmpIT (P = 0.113 and P = 0.445, respectively).Patients with resected AmpPB and dCCA appear to benefit from ACT. While the optimal ACT for AmpPB remains undetermined, it appears that dCCA shows the most favourable response to capecitabine monotherapy. Tailored adjuvant treatments are essential for enhancing prognosis across all four non-pancreatic periampullary adenocarcinomas.© 2024. The Author(s), under exclusive licence to Springer Nature Limited.