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ホンダ ゴロウ
HONDA Gorou
本田 五郎 所属 医学部 医学科（東京女子医科大学病院） 職種 教授・基幹分野長 |
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| 論文種別 | 原著 |
| 言語種別 | 英語 |
| 査読の有無 | 査読あり |
| 表題 | The impact of neoadjuvant therapy in patients with left-sided resectable pancreatic cancer: an international multicenter study. |
| 掲載誌名 | 正式名：Annals of oncology 略 称：Ann Oncol ISSNコード：15698041/09237534 |
| 掲載区分 | 国外 |
| 巻・号・頁 | 36(5),pp.529-542 |
| 著者・共著者 | E Rangelova, T F Stoop, T M E van Ramshorst, M Ali, E A van Bodegraven, A A Javed, D Hashimoto, E Steyerberg, A Banerjee, A Jain, A Sauvanet, A Serrablo, A Giani, A Giardino, A Zerbi, A Arshad, A G Wijma, A Coratti, A Zironda, A Socratous, A Rojas, A Halimi, A Ejaz, A Oba, B Y Patel, B Björnsson, B N Reames, B Tingstedt, B K P Goh, C Payá-Llorente, C D Del Pozo, C González-Abós, C Medin, C H J van Eijck, C de Ponthaud, C Takishita, C Schwabl, C Månsson, C Ricci, C A Thiels, D Douchi, D L Hughes, D Kilburn, D Flanking, D Kleive, D S Silva, B H Edil, E Pando, E Moltzer, E F Kauffman, E Warren, E Bozkurt, E Sparrelid, E Thoma, E Verkolf, F Ausania, F Giannone, F J Hüttner, et.al |
| 発行年月 | 2025/05 |
| 概要 | BACKGROUND:Left-sided pancreatic cancer is associated with worse overall survival (OS) compared with right-sided pancreatic cancer. Although neoadjuvant therapy is currently seen as not effective in patients with resectable pancreatic cancer (RPC), current randomized trials included mostly patients with right-sided RPC. The purpose of this study was to assess the association between neoadjuvant therapy and OS in patients with left-sided RPC compared with upfront surgery.PATIENTS AND METHODS:This was an international multicenter retrospective study including consecutive patients after left-sided pancreatic resection for pathology-proven RPC, either after neoadjuvant therapy or upfront surgery in 76 centers from 18 countries on 4 continents (2013-2019). The primary endpoint was OS from diagnosis. Time-dependent Cox regression analysis was carried out to investigate the association of neoadjuvant therapy with OS, adjusting for confounders at the time of diagnosis. Adjusted OS probabilities were calculated.RESULTS:Overall, 2282 patients after left-sided pancreatic resection for RPC were included of whom 290 patients (13%) received neoadjuvant therapy. The most common neoadjuvant regimens were (m)FOLFIRINOX (38%) and gemcitabine-nab-paclitaxel (22%). After upfront surgery, 72% of patients received adjuvant chemotherapy, mostly a single-agent regimen (74%). Neoadjuvant therapy was associated with prolonged OS compared with upfront surgery (adjusted hazard ratio 0.69, 95% confidence interval 0.58-0.83) with an adjusted median OS of 53 versus 37 months (P = 0.0003) and adjusted 5-year OS rates of 47% versus 35% (P = 0.0001) compared with upfront surgery. Interaction analysis demonstrated a stronger effect of neoadjuvant therapy in patients with a larger tumor (Pinteraction = 0.003) and higher serum carbohydrate antigen 19-9 (CA19-9; Pinteraction = 0.005). In contrast, the effect of neoadjuvant therapy was not enhanced for splenic artery (Pinteraction = 0.43), splenic vein (Pinteraction = 0.30), retroperitoneal (Pinteraction = 0.84), and multivisceral (Pinteraction = 0.96) involvement.CONCLUSIONS:Neoadjuvant therapy in patients with left-sided RPC was associated with improved OS compared with upfront surgery. The impact of neoadjuvant therapy increased with larger tumor size and higher serum CA19-9 at diagnosis. Randomized controlled trials on neoadjuvant therapy specifically in patients with left-sided RPC are needed. |
| DOI | 10.1016/j.annonc.2024.12.015 |
| PMID | 39814200 |