医学
新辅助治疗
内科学
腺癌
肿瘤科
纳特
多元分析
胰腺导管腺癌
单变量分析
优势比
完全响应
胃肠病学
胰腺癌
癌症
化疗
计算机网络
乳腺癌
计算机科学
作者
Amro M. Abdelrahman,Ajit H. Goenka,Roberto Alva-Ruiz,Jennifer A. Yonkus,Jennifer L. Leiting,Rondell P. Graham,Kenneth W. Merrell,Cornelius A. Thiels,Christopher L. Hallemeier,Susanne G. Warner,Michael G. Haddock,Travis E. Grotz,Nguyen H. Tran,Rory L. Smoot,Wen Wee,Sean P. Cleary,Robert R. McWilliams,David M. Nagorney,Thorvardur R. Halfdanarson,Michael L. Kendrick,Mark J. Truty
出处
期刊:Journal of The National Comprehensive Cancer Network
日期:2022-09-01
卷期号:20 (9): 1023-1032.e3
被引量:18
标识
DOI:10.6004/jnccn.2022.7041
摘要
Neoadjuvant therapy (NAT) is used in borderline resectable/locally advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC). Anatomic imaging (CT/MRI) poorly predicts response, and biochemical (CA 19-9) markers are not useful (nonsecretors/nonelevated) in many patients. Pathologic response highly predicts survival post-NAT, but is only known postoperatively. Because metabolic imaging (FDG-PET) reveals primary tumor viability, this study aimed to evaluate our experience with preoperative FDG-PET in patients with BR/LA PDAC in predicting NAT response and survival.We reviewed all patients with resected BR/LA PDAC who underwent NAT with FDG-PET within 60 days of resection. Pre- and post-NAT metabolic (FDG-PET) and biochemical (CA 19-9) responses were dichotomized in addition to pathologic responses. We compared post-NAT metabolic and biochemical responses as preoperative predictors of pathologic responses and recurrence-free survival (RFS) and overall survival (OS).We identified 202 eligible patients. Post-NAT, 58% of patients had optimization of CA 19-9 levels. Major metabolic and pathologic responses were present in 51% and 38% of patients, respectively. Median RFS and OS times were 21 and 48.7 months, respectively. Metabolic response was superior to biochemical response in predicting pathologic response (area under the curve, 0.86 vs 0.75; P<.001). Metabolic response was the only univariate preoperative predictor of OS (odds ratio, 0.25; 95% CI, 0.13-0.40), and was highly correlated (P=.001) with pathologic response as opposed to biochemical response alone. After multivariate adjustment, metabolic response was the single largest independent preoperative predictor (P<.001) for pathologic response (odds ratio, 43.2; 95% CI, 16.9-153.2), RFS (hazard ratio, 0.37; 95% CI, 0.2-0.6), and OS (hazard ratio, 0.21; 95% CI, 0.1-0.4).Among patients with post-NAT resected BR/LA PDAC, FDG-PET highly predicts pathologic response and survival, superior to biochemical responses alone. Given the poor ability of anatomic imaging or biochemical markers to assess NAT responses in these patients, FDG-PET is a preoperative metric of NAT efficacy, thereby allowing potential therapeutic alterations and surgical treatment decisions. We suggest that FDG-PET should be an adjunct and recommended modality during the NAT phase of care for these patients.