据报道，目前的AJCC 8th对已切除的交界性可切除胰腺癌和新辅助化疗后局部晚期胰腺癌患者的预后预测能力较差。本研究旨在通过结合病理学和生物反应（BR）参数来开发改进的预后模型。进行了一项回顾性队列研究，包括化疗后接受治疗性手术的患者。我们开发了改进的 ypT 分期系统并纳入 BR，涉及碳水化合物抗原 19-9 的正常化和化疗后同时降低最大标准化摄取值。比较了现行病理系统、改良病理系统以及新开发的病理与BR相结合的系统的预后表现。在这项研究中，171名患者在化疗后接受了手术。修改后的 T 分期统一了 ypT2 和 ypT3，与当前分期系统相比，其预后性能有所改善（曲线下面积：0.706 与 0.661）。生物学无反应是生存较差的独立预后因素（风险比2.31，95%置信区间1.50-3.55，P<0.001）。与现有病理系统（曲线下面积：0.785 vs. 0.661，P=0.010）和改良病理分期系统（曲线下面积：0.785）相比，改良BR系统的病理学在预测5年总生存方面表现出最高的判别能力。 vs. 0.706，P=0.002)。该预后模型同时结合了改良的 ypT 分期和升高的碳水化合物抗原 19-9 水平以及最大标准化摄取值，证明了在预测新辅助化疗后接受手术的患者的肿瘤结局方面有更好的结果。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 出版

The current AJCC 8th has been reported to have a poor ability to predict the prognosis in patients with resected borderline resectable pancreatic cancer and locally advanced pancreatic cancer following neoadjuvant chemotherapy. This study was aimed to develop an improved prognostic model by incorporating pathology and parameters of biologic response (BR).A retrospective cohort study was conducted including patients who underwent curative-intent surgery following chemotherapy. We developed a modified ypT staging system and incorporated the BR, involving normalization of carbohydrate antigen 19-9 and reduction in the maximum standardized uptake value simultaneously after chemotherapy. The prognostic performance of the current pathologic system, modified pathologic system, and newly developed system incorporating pathology and BR were compared.In this study, 171 patients underwent surgery following chemotherapy. The modified T stage, which unified ypT2 and ypT3, demonstrated improved prognostic performance than the current staging system (area under the curve: 0.706 vs. 0.661). Biologic unresponsiveness was an independent prognostic factor for worse survival (hazard ratio 2.31, 95% confidence interval 1.50-3.55, P<0.001). The modified pathology with BR system demonstrated the highest discriminative ability in predicting 5-year overall survival than the current pathologic system (area under the curve: 0.785 vs. 0.661, P=0.010) and modified pathologic staging system (area under the curve: 0.785 vs. 0.706, P=0.002).The prognostic model, incorporating modified ypT staging and elevated carbohydrate antigen 19-9 levels and maximum standardized uptake value simultaneously, demonstrated improved results in predicting oncologic outcomes for patients who underwent surgery following neoadjuvant chemotherapy.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.