BACKGROUND Neoadjuvant therapy (NT) is increasingly utilized for patients with pancreatic ductal adenocarcinoma (PDAC) but the nationwide incidence and long-term prognosis of a pathologic complete response (pCR) remains poorly understood. METHODS Patients with localized PDAC and known cT and pT stage who received NT prior to pancreatectomy from 2004 to 2016 were identified using the National Cancer Database. The clinicopathologic characteristics and long-term outcomes of patients who did and did not experience a pCR were compared. RESULTS Among 7,902 patients who underwent NT prior to pancreatectomy, 244 (3.1%) experienced a pCR while 7,658 (96.9%) did not. On multivariable regression, longer duration of NT (OR 1.20, 95% CI 1.14-1.27 per month) and use of preoperative radiation (OR 9.98, 95% CI 3.05-32.71) were independently associated with a pCR. Median overall survival (OS) was longer among patients who experienced a pCR (77 vs 26 months, p < 0.001). On multivariate analysis, pCR was the strongest predictor of improved OS (HR 0.43, 95%CI 0.32-0.58, p < 0.001). CONCLUSION A pCR following NT for PDAC occurs infrequently but is associated with significantly improved OS. Better predictors of response and more effective preoperative regimens should be aggressively sought.

中文翻译：

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胰腺导管腺癌新辅助治疗后的病理完全缓解：确定发病率、预测因素和结果。

背景 新辅助治疗 (NT) 越来越多地用于胰腺导管腺癌 (PDAC) 患者，但病理完全缓解 (pCR) 的全国发病率和长期预后仍然知之甚少。方法使用国家癌症数据库确定 2004 年至 2016 年在胰腺切除术前接受 NT 的局限性 PDAC 和已知 cT 和 pT 分期的患者。比较了经历和未经历 pCR 的患者的临床病理学特征和长期结局。结果 在胰腺切除术前接受 NT 的 7,902 名患者中，244 名 (3.1%) 经历了 pCR，而 7,658 名 (96.9%) 没有。在多变量回归中，NT 持续时间较长（OR 1.20，95% CI 1.14-1.27 每月）和术前放疗的使用（OR 9.98，95% CI 3.05-32。71) 与 pCR 独立相关。经历 pCR 的患者中位总生存期 (OS) 更长（77 个月 vs 26 个月，p < 0.001）。在多变量分析中，pCR 是改善 OS 的最强预测因子（HR 0.43，95%CI 0.32-0.58，p < 0.001）。结论 PDAC NT 后的 pCR 很少发生，但与显着改善的 OS 相关。应积极寻求更好的反应预测指标和更有效的术前治疗方案。