根据碳水化合物抗原 19-9 水平改变化疗方案的新辅助治疗可切除/交界可切除胰腺导管腺癌。
Neoadjuvant Treatment with Changes in Chemotherapy Regimens According to Carbohydrate Antigen 19-9 Level for Resectable/Borderline Resectable Pancreatic Ductal Adenocarcinoma.
发表日期：2024 Oct 21
作者：
Daisuke Hashimoto, Sohei Satoi, So Yamaki, Shinji Nakayama, Nobuhiro Shibata, Kazuki Matsumura, Hidetaka Miyazaki, Yuki Matsui, Denys Tsybulskyi, Nguyen Thanh Sang, Tsukasa Ikeura, Masashi Kanai, Mitsugu Sekimoto
来源：
ANNALS OF SURGICAL ONCOLOGY
摘要：
碳水化合物抗原 (CA) 19-9 对胰腺导管腺癌 (PDAC) 新辅助治疗 (NAT) 的反应可能有助于治疗结果。本研究旨在探讨基于 CA19-9 水平改变 NAT 方案的影响。这项单中心回顾性研究纳入了 2008 年至 2022 年接受 NAT 的可切除/临界可切除 (R/BR)-PDAC 患者。 CA19-9 NAT后水平低于150 IU/mL是切除的标准。如果水平没有下降，则改变化疗方案以满足标准。将患者队列分为A组（满足标准，未改变化疗）、B组（未接受化疗改变，不能满足标准）、C组（接受化疗改变，满足标准）、D组（接受化疗）变化，无法满足标准）。研究队列包括 283 名患者。一线化疗后，112 名患者 (39.6%) 不满足标准（B 组 [n = 64]、C 组 [n = 32] 和 D 组 [n = 16]）。在 283 名患者中，48 名 (17%) 接受了化疗改变（C 组和 D 组）。 C组和D组患者的总生存期（OS，35.9个月）明显优于B组患者（25.7个月）（P = 0.035）。 C 组患者的 OS（63.8 个月）与 A 组患者的 OS 相似（n = 171：56.3 个月；P = 0.430）。对 B、C 和 D 组患者的多变量分析表明，化疗改变是 OS 和无进展生存期的独立预后因素。改变针对 CA19-9 水平的化疗可以改善 R/BR-PDAC 患者的预后对一线 NAT 的生物学反应较差。© 2024。外科肿瘤学会。
The response of carbohydrate antigen (CA) 19-9 to neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) may contribute to outcomes. This study aimed to investigate the effect of changes in NAT regimens based on CA19-9 level.This single-center retrospective study included patients with resectable/borderline resectable (R/BR)-PDAC undergoing NAT from 2008 to 2022. A CA19-9 level lower than 150 IU/mL after NAT was the criterion for resection. If the level did not decrease, the chemotherapy regimen was changed to satisfy the criterion. The patient cohort was divided into group A (satisfied criterion without changing chemotherapy), group B (did not receive chemotherapy change, could not satisfy the criterion), group C (received chemotherapy change, satisfied the criterion), and group D (received chemotherapy change, could not satisfy the criterion).The study cohort included 283 patients. After first-line chemotherapy, 112 (39.6%) patients did not satisfy the criterion (groups B [n = 64], C [n = 32], and D [n = 16]). Of the 283 patients, 48 (17%) received a chemotherapy change (groups C and D). The patients in groups C and D showed significantly better overall survival (OS, 35.9 months) than the group B patients (25.7 months) (P = 0.035). The OS of the group C patients (63.8 months) was similar to the OS of the group A patients (n = 171: 56.3 months; P = 0.430). Multivariate analysis of the patients in groups B, C, and D identified chemotherapy change as an independent prognostic factor for OS and progression-free survival.Changing the chemotherapy targeting the CA19-9 level can improve the outcome of R/BR-PDAC patients with poor biologic response to first-line NAT.© 2024. Society of Surgical Oncology.