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中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (05) : 629 -633. doi: 10.3877/cma.j.issn.2095-3232.2024.05.007

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胰腺癌新辅助化疗后可切除性评估现状及进展
张昊1, 潘卫东1,()   
  1. 1. 510655 广州,中山大学附属第六医院普通外科(胰腺肝胆外科);510655 广州市黄埔区中山六院生物医学创新研究院
  • 收稿日期:2024-05-29 出版日期:2024-10-10
  • 通信作者: 潘卫东
  • 基金资助:
    国家临床重点专科; 广东省消化系统疾病临床医学研究中心项目(2020B1111170004)

Current status and progress in assessment of resectability of pancreatic cancer after neoadjuvant chemotherapy

Hao Zhang1, Weidong Pan1,()   

  1. 1. Department of General Surgery (Department of Hepato-Biliary-Pancreatic Surgery), the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China; Biomedical Innovation Institute of the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
  • Received:2024-05-29 Published:2024-10-10
  • Corresponding author: Weidong Pan
引用本文:

张昊, 潘卫东. 胰腺癌新辅助化疗后可切除性评估现状及进展[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 629-633.

Hao Zhang, Weidong Pan. Current status and progress in assessment of resectability of pancreatic cancer after neoadjuvant chemotherapy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 629-633.

胰腺癌是预后最差的肿瘤之一,R0手术切除是患者获得长期生存的唯一方式。为提高R0切除率,美国国立综合癌症网络(NCCN)指南建议对临界可切除及局部进展期患者优先行新辅助化疗。但新辅助化疗后,尤其是临界可切除患者的肿瘤可切除性评估给外科医师带来不小的困难。CT及MRI都存在低估肿瘤可切除性的倾向。建议动态检测CA19-9、评估影像学资料及患者全身一般情况、MDT讨论患者手术能否获益。必要时,依据患者个体情况行PET-CT、二代测序、循环肿瘤DNA检测协助判断。随着影像组学、人工智能(AI)阅片、基因检测、液体活检等临床证据的不断完善,外科医师将对肿瘤可切除性做出更加精准的预判。

Pancreatic cancer is one of the tumors with the worst prognosis. R0 resection is the only option to achieve long-term survival. To improve the R0 resection rate, National Comprehensive Cancer Network (NCCN) guidelines recommends neoadjuvant chemotherapy for borderline resectable and locally advanced stage patients. However, the assessment of tumor resectability after neoadjuvant chemotherapy, especially in borderline resectable patients, brings huge challenges to surgeons. Both CT and MRI tend to underestimate the resectability of tumors. Dynamic detection of CA19-9, evaluation of imaging data and general condition and MDT consultation are recommended to evaluate whether patients can benefit from surgery. PET-CT, next-generation sequencing and circulating tumor DNA detection should be performed to assist diagnosis when necessary according to the individual conditions of patients. With persistent advancement of clinical evidence such as imaging, artificial intelligence (AI)-assisted film reading, genetic testing and liquid biopsy, surgeons will deliver more accurate prediction for tumor resectability.

[1]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016[J]. CA Cancer J Clin, 2016, 66(1):7-30.
[2]
Groot VP, Rezaee N, Wu W, et al. Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma[J]. Ann Surg, 2018, 267(5):936-945.
[3]
Michelakos T, Pergolini I, Castillo CF, et al. Predictors of resectability and survival in patients with borderline and locally advanced pancreatic cancer who underwent neoadjuvant treatment with FOLFIRINOX[J]. Ann Surg, 2019, 269(4):733-740.
[4]
Jang JK, Byun JH, Kang JH, et al. CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy[J]. Eur Radiol, 2021, 31(2):813-823.
[5]
Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer[J]. Ann Surg, 2015, 261(1):12-17.
[6]
Marchegiani G, Todaro V, Boninsegna E, et al. Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection[J]. Eur Radiol, 2018, 28(10):4265-4273.
[7]
Yoo J, Lee JM, Joo I, et al. Post-neoadjuvant treatment pancreatic cancer resectability and outcome prediction using CT, 18F-FDG PET/MRI and CA 19-9[J]. Cancer Imaging, 2023, 23(1):49.
[8]
Rayamajhi S, Balachandran A, Katz M, et al. Utility of (18)F-FDG PET/CT and CECT in conjunction with serum CA 19-9 for detecting recurrent pancreatic adenocarcinoma[J]. Abdom Radiol, 2018, 43(2):505-513.
[9]
蔡伟, 马霄虹, 赵心明. CT评估和预测局部进展期胰腺癌综合治疗疗效的研究进展[J]. 国际医学放射学杂志, 2022, 45(5):572-576.
[10]
Rose JB, Edwards AM, Rocha FG, et al. Sustained carbohydrate antigen 19-9 response to neoadjuvant chemotherapy in borderline resectable pancreatic cancer predicts progression and survival[J]. Oncologist, 2020, 25(10):859-866.
[11]
Truty MJ, Kendrick ML, Nagorney DM, et al. Factors predicting response, perioperative outcomes, and survival following total neoadjuvant therapy for borderline/locally advanced pancreatic cancer[J]. Ann Surg, 2021, 273(2):341-349.
[12]
Boone BA, Steve J, Zenati MS, et al. Serum CA19-9 response to neoadjuvant therapy is associated with outcome in pancreatic adenocarcinoma[J]. Ann Surg Oncol, 2014, 21(13):4351-4358.
[13]
Beleù A, Calabrese A, Rizzo G, et al. Preoperative imaging evaluation after downstaging of pancreatic ductal adenocarcinoma: a multi-center study[J]. Cancers, 2019, 11(2):267.
[14]
Panda A, Garg I, Truty MJ, et al. Borderline resectable and locally advanced pancreatic cancer: FDG PET/MRI and CT tumor metrics for assessment of pathologic response to neoadjuvant therapy and prediction of survival[J]. AJR Am J Roentgenol, 2021, 217(3):730-740.
[15]
Abdelrahman AM, Goenka AH, Alva-Ruiz R, et al. FDG-PET predicts neoadjuvant therapy response and survival in borderline resectable/locally advanced pancreatic adenocarcinoma[J]. J Natl Compr Canc Netw, 2022, 20(9):1023-1032, e3.
[16]
Oba A, Del Chiaro M, Satoi S, et al. New criteria of resectability for pancreatic cancer: a position paper by the Japanese society of hepato-biliary-pancreatic surgery (JSHBPS)[J]. J Hepatobiliary Pancreat Sci, 2022, 29(7):725-731.
[17]
Golan T, Barenboim A, Lahat G, et al. Increased rate of complete pathologic response after neoadjuvant FOLFIRINOX for BRCA mutation carriers with borderline resectable pancreatic cancer[J]. Ann Surg Oncol, 2020, 27(10):3963-3970.
[18]
Golan T, Hammel P, Reni M, et al. Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer[J]. N Engl J Med, 2019, 381(4):317-327.
[19]
Strickler JH, Satake H, George TJ, et al. Sotorasib in KRAS p.G12C-mutated advanced pancreatic cancer[J]. N Engl J Med, 2023, 388(1):33-43.
[20]
Moffitt RA, Marayati R, Flate EL, et al. Virtual microdissection identifies distinct tumor- and stroma-specific subtypes of pancreatic ductal adenocarcinoma[J]. Nat Genet, 2015, 47(10):1168-1178.
[21]
Chan-Seng-Yue M, Kim JC, Wilson GW, et al. Transcription phenotypes of pancreatic cancer are driven by genomic events during tumor evolution[J]. Nat Genet, 2020, 52(2):231-240.
[22]
Edland KH, Tjensvoll K, Oltedal S, et al. Monitoring of circulating tumour DNA in advanced pancreatic ductal adenocarcinoma predicts clinical outcome and reveals disease progression earlier than radiological imaging[J]. Mol Oncol, 2023, 17(9):1857-1870.
[23]
郑诗凡, 李凡露, 邹思奕, 等. 精准医学时代可切除胰腺癌新辅助治疗的研究现状与展望[J]. 中华普通外科杂志, 2024, 39(1):61-65.
[24]
Seppälä TT, Zimmerman JW, Suri R, et al. Precision medicine in pancreatic cancer: patient-derived organoid pharmacotyping is a predictive biomarker of clinical treatment response[J]. Clin Cancer Res, 2022, 28(15):3296-3307.
[25]
Liu Y, Li N, Zhu Y. Pancreatic organoids: a frontier method for investigating pancreatic-related diseases[J]. Int J Mol Sci, 2023, 24(4):4027.
[26]
国家卫生健康委办公厅. 胰腺癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38(5):1006-1015.
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