新辅助化疗对不同类型边界可切除胰腺癌的近期疗效的影响

Clinical impact of neoadjuvant chemotherapy on different types of borderline resectable pancreatic cancer

目的探讨新辅助化疗对不同类型交界可切除胰腺癌的临床效果。方法回顾性分析2017年1月至2021年8月北医三院收治的交界可切除胰腺癌患者的临床资料,筛选出符合标准的患者46例,其中26例动脉交界可切除胰腺癌(arterial borderline resectable pancreatic cancer,ABRPC),20例静脉交界可切除胰腺癌(venous borderline resectable pancreatic cancer,VBRPC),18例VBRPC和15例ABRPC患者随后顺利完成手术治疗。评估新辅助化疗的疗效,比较新辅化疗前后体质量指数、肿瘤直径、肿瘤标志物等指标变化。分析两组患者的手术切除率、总生存期(overall survival,OS)等临床数据,评估新辅助化疗在不同类型交界可切除胰腺癌患者中的临床疗效。结果新辅助化疗后CA19-9水平明显降低(P<0.05),其他指标差异均无统计学意义(P>0.05)。新辅助化疗后接受手术组患者和放弃手术者组患者比较,肿瘤的直径在影像上明显缩小(P<0.05),其他指标差异均无统计学意义(P>0.05)。VBRPC组和ABRPC组短期生存率、OS、R0切除率、住院期间发生Clavien-Dindo分级≥Ⅱ级手术并发症的发生率差异均无统计学意义(P>0.05),VBRPC组的手术切除率90.0%优于ABRPC组57.7%,差异有统计学意义(P=0.037)。结论新辅助化疗后肿瘤直径较前明显进展的患者,很难从新辅助化疗中获益;VBRPC患者接受新辅助化疗后,手术切除率较ABRPC患者高。

Objective To investigate the clinical effects of neoadjuvant chemotherapy on different types of borderline resectable pancreatic cancer.Methods The clinical data of 46 patients with borderline resectable pancreatic cancer admitted to Peking University Third Hospital from Jan 2017 to Aug 2021 were retrospectively analyzed,including 26 with arterial borderline resectable pancreatic cancer(ABRPC)and 20 with venous borderline resectable pancreatic cancer(VBRPC).Eighteen patients of VBRPC and 15 patients of ABRPC were then successfully received surgical resection.Results After neoadjuvant chemotherapy,CA19-9 levels decreased significantly(P<0.05),while other indicators were not statistically different(P>0.05).Compared with the non-surgical group,the diameter of the tumour was significantly reduced after neoadjuvant chemotherapy(P<0.05).The surgical resection rate of 90.0%in the VBRPC group was higher than that of 57.7%in the ABRPC group(P=0.037).Conclusions Patients with significantly tumour progress after neoadjuvant chemotherapy are difficult to benefit from neoadjuvant chemotherapy;Venous borderline resectable pancreatic cancer patients had a higher surgical resection rate than those with ABRPC after neoadjuvant chemotherapy.