| Background and ObjectivePancreatic cancer is one of the most malignant and lethal tumors as ever known,with a five-year survival rate of less than 10%,causing the fourth highest number of deaths in both men and women,and more than half of patients die within two years of pathological diagnosis.It has become a major threat to the health of all human beings.The survival rate of pancreatic cancer still does not seem to have been substantially improved for a long time,which puts a huge pressure on the medical resources of the society.Until now,radical resection has been the only promising way to cure pancreatic cancer.However,close to 90% of patients have tumors that are no longer limited to the primary site at the time of diagnosis,and more than half of them have combined distant metastases.The inability to improve the survival rate of pancreatic cancer after radical resection is probably related to the presence of occult micrometastases at the time of resection and the special microenvironment of pancreatic cancer,as well as the lack of effectiveness of previous postoperative adjuvant therapies.Based on the above issues,neoadjuvant/conversion therapy has been increasingly used in the treatment of pancreatic cancer in recent years.Several foreign clinical studies have confirmed that neoadjuvant/conversion therapy can effectively improve the overall survival of patients compared with upfront surgery.Currently,there are no clinical researches with large samples evaluating the clinical outcomes of neoadjuvant/conversion therapy for pancreatic cancer in China.The purpose of this study was to follow the neoadjuvant/conversion therapy in our center,especially in patients with pancreatic cancer who completed radical surgery.To explore the factors that affect patient outcomes and provide guidance and reference for the subsequent clinical practice of neoadjuvant/conversion therapy.Materials and MethodsRecords of visits to the pancreatic cancer MDT at the our centre between February2017 and February 2021 were retrospectively collected to identify the cohort of pancreatic cancer patients receiving neoadjuvant/conversion therapy.From these,patients with pancreatic cancer who completed radical resection were screened to analyze the factors influencing survival and to further explore the factors.Methods include Kaplan-Meier analysis,COX regression multivariate survival analysis,logistic regression multivariate analysis,nomogram modeling.ResultsPart I: Relying on the MDT model,160 of the 293(54.6%)neoadjuvant/conversion therapy patients completed radical resection.The resection rate of neoadjuvant therapy was80.0% while that of conversion therapy was 39.3%.Variations during this period were mainly reductions in the maximum tumor diameter and decreases in tumor markers of CA19-9 and CEA,but it was less likely that there was significant regression on imaging examinations.The resection rate was on par with foreign researches.Part II: The median OS of the 160 neoadjuvant/conversion therapy that completed radical surgery was 30.8 months,the median PFS was 24.3 months,and the R0 resection rate was 77.5%.Patients had a relatively lower rate of perioperative complications.Major pathologic response was the only clinical factor that both predicted patient OS and PFS.In addition,normalization of CA19-9 and CA72-4,negative lymph nodes,and adjuvant therapy were also independent positive predictors for OS.Part III: To explore the preoperative predictors of major pathologic response in 160 patients who completed radical surgery after neoadjuvant/conversion therapy,with CA19-9normalization,Systemic Immune-Inflammation Index(SII)lower than 530 after therapy,and the use of radiation therapy found to be independent predictors of major pathologic response,the nomogram prediction model consisting of all above three was effective in predicting major pathologic response of validation cohort.ConclusionsPatients who complete radical resection after neoadjuvant/conversion therapy have a better prognosis,and CA19-9 normalization is an important predictor of patient survival and therapy outcome,and major pathologic response prediction model developed in this study can provide a reference for subsequent treatment... |
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