交界可切除胰腺癌新辅助化疗联合免疫治疗的回顾性临床分析

A retrospective clinical study on neoadjuvant chemotherapy combined with immunotherapy to treat patient with borderline resectable pancreatic adenocarcinoma

目的探讨新辅助化疗联合免疫治疗在交界可切除胰腺癌患者中的应用价值。方法回顾性分析2019年1月至2021年6月在解放军总医院第五医学中心就诊的拟行围手术期治疗及手术治疗的胰腺癌患者的临床资料。共纳入22例胰腺癌患者,其中男性10例,女性12例,年龄(56.0±10.2)岁。术前接受白蛋白结合型紫杉醇联合替吉奥(AS)方案新辅助化疗联合程序性死亡蛋白-1(PD-1)单抗治疗。对患者的治疗效果、手术病理及预后情况进行分析。结果22例新辅助化疗联合PD-1单抗治疗的患者中,11例(50%)患者肿瘤位于胰腺头颈部及钩突部。疗效评价中有1例患者影像学评估达到完全缓解(4.5%,1/22),9例达到部分缓解(40.9%,9/22),11例达到疾病稳定(50.0%,11/22)。所有患者均行R0切除。术后pTNM分期中91%(20/22)患者为IA~IIB期,pT2患者占31.8%(7/22),N0患者占63.6%(14/22)。1例化疗联合免疫治疗的患者达到病理完全缓解。13例(54.2%,13/22)患者接受术后辅助治疗。患者中位无复发生存期(RFS)和中位疾病进展时间(TTP)分别为6.4和12.8个月。患者的中位生存时间未达到。术后病理TNM分期IIA~III期(HR=3.63,95%CI:1.18~11.20,P=0.025)、术后病理T2~3分期(HR=2.02,95%CI:1.01~5.05,P=0.049)与RFS相关。术后病理TNM分期IIA~III期(HR=2.39,95%CI:1.04~5.50,P=0.041)和术后病理T2~3分期(HR=2.53,95%CI:1.26~5.09,P=0.009)与TTP相关。结论AS联合PD-1单抗在交界可切除胰腺癌患者的新辅助治疗中具有较好的有效率。

Objective To study the combined use of neoadjuvant chemotherapy and immunotherapy in patients with borderline resectable pancreatic cancer.Methods The clinical data of patients with pancreatic cancer who were planned to undergo perioperative treatment before surgical treatment at the Fifth Medical Center of PLA General Hospital from January 2019 to June 2021 were retrospectively studied.Of 22 patients with pancreatic cancer,there were 10 males and 12 females,aged(56.0±10.2)years old.Preoperative treatment with chemotherapy(nab-paclitaxel and S-1,AS)and immunotherapy regimen before surgery were given.The baseline characteristics,treatment efficacy,surgical pathology and prognosis were analyzed.Results Of 22 patients who were treated with neoadjuvant chemotherapy combined with programmed death-1(PD-1)monoclonal antibody,11 patients(50%)had tumors in the head,neck and uncinated process of pancreas.On radiographic assessment,one patient achieved CR(4.5%,1/22),9 patients PR(40.9%,9/22),and 11 patients SD(50.0%,11/22).All patients subsequently underwent R0 resection.The postoperative pTNM staging showed 91%(20/22)of patients were in stage IA-IIB,31.8%(7/22)of patients had pT2,63.6%(14/22)had N0,and 1 patient had pCR.Thirteen patients(54.2%,13/22)received postoperative adjuvant therapy.The median recurrence-free survival(RFS)was 6.4 months and the median time to progression(TTP)was 12.8 months.The median overall survival of patients was not reached.Postoperative pathology TNM staging IIA to III(HR=3.63,95%CI:1.18-11.20,P=0.025)and postoperative pathology T2-3 stage(HR=2.02,95%CI:1.01-5.05,P=0.049)were significantly associated with RFS.Postoperative pathology TNM stages IIA to III(HR=2.39,95%CI:1.04-5.50,P=0.041)and postoperative pathology T2-3 stage(HR=2.53,95%CI:1.26-5.09,P=0.009)were significantly associated with TTP.Conclusion AS combined with PD-1 monoclonal antibody showed good efficacy as a neoadjuvant therapy for patients with borderline-resectable pancreatic cancer.