OBJECTIVE The present study aimed to assess the efficacy of this approach and establish the criteria that identify LAPC patients who may achieve survival benefits from RRCIA. SUMMARY BACKGROUND DATA Surgical resection for locally advanced pancreatic cancer (LAPC) remains challenging and associated with high morbidity and mortality, especially for surgery with major arterial reconstruction. We previously showed the feasibility and safety of Radical Resection Combined with Intestinal Autotransplantation (RRCIA) after systemic treatment. METHODS A retrospectively observational and prospectively validated study with three cohorts was conducted using multiple treatments. Overall survival (OS) and progression-free survival (PFS) were compared for both analyses. Propensity-score matching (PSM) and stabilized inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders. RESULTS Among 208 patients with LAPC we identified 48 who underwent systemic treatment followed by RRCIA. Using Propensity-score matching (PSM) and stabilized inverse probability of treatment weighting (IPTW) analyses, we observed that patients who underwent RRCIA had better overall and progression free survival compared with patients who did not have surgery (PSM cohort: median OS: 25.8 mo vs. 14.2 mo, P=0.0031, and IPTW cohort: median OS: 23.2 mo vs. 15.4 mo, P=0.0069) and PFS (PSM cohort: median PFS: 13.3 mo vs. 7.0 mo, P=0.0246, and IPTW cohort: median OS: 13.3 mo vs. 8.8 mo, P=0.002). Further prospective analysis showed that patients who received systemic treatment followed by RRCIA were associated with improved OS and PFS compared with patients who were eligible but did not receive RRCIA (median OS: 22.6 mo vs. 18.2 mo, P=0.035; median PFS: 13.2 mo vs. 10.3 mo, P=0.0412). Moreover, stratified and multivariable analysis demonstrated that preoperative CA19-9 normalization and duration of initial treatment over 8 cycles were predictors for precise selection of patients who would benefit from RRCIA. Meanwhile, adjuvant therapy after RRCIA was a significant factor for improving survival. CONCLUSION This study suggests that RRCIA appears to be effective and associated with improved outcomes for LAPC patients with favorable response to systemic treatment. LAPC patients Should have at least 8 cycles of systemic treatment and CA19-9 normalization to be considered for RRCIA.

中文翻译：

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局部晚期胰腺癌的全身治疗后根治性切除术联合肠道自体移植 （RRCIA）：一项回顾性观察和前瞻性验证研究。


目的 本研究旨在评估这种方法的有效性，并建立识别可能从 RRCIA 获得生存获益的 LAPC 患者的标准。总结背景数据局部晚期胰腺癌 （LAPC） 的手术切除仍然具有挑战性，并且与高发病率和死亡率相关，尤其是对于大动脉重建手术。我们之前展示了全身治疗后根治性切除术联合肠道自体移植 （RRCIA） 的可行性和安全性。方法 使用多种治疗对三个队列进行了一项回顾性观察和前瞻性验证研究。比较两种分析的总生存期 （OS） 和无进展生存期 （PFS）。进行倾向评分匹配 （PSM） 和稳定逆概率治疗加权 （IPTW） 以调整潜在的混杂因素。结果 在 208 例 LAPC 患者中，我们确定了 48 例接受了全身治疗，然后接受了 RRCIA。使用倾向评分匹配 （PSM） 和稳定治疗加权逆概率 （IPTW） 分析，我们观察到与未接受手术的患者相比，接受 RRCIA 的患者具有更好的总生存期和无进展生存期（PSM 队列：中位 OS：25.8 个月对 14.2 个月，P = 0.0031，IPTW 队列：中位 OS：23.2 个月对 15.4 个月， P=0.0069）和 PFS （PSM 队列：中位 PFS：13.3 个月 vs. 7.0 个月，P = 0.0246，IPTW 队列：中位 OS：13.3 个月 vs. 8.8 个月，P = 0.002）。进一步的前瞻性分析显示，与符合条件但未接受 RRCIA 的患者相比，接受全身治疗后接受 RRCIA 的患者与 OS 和 PFS 改善相关（中位 OS：22.6 个月对 18.2 个月，P = 0.035;中位 PFS：13.2 个月对 10.3 个月，P = 0。此外，分层和多变量分析表明，术前 CA19-9 正常化和 8 个周期的初始治疗持续时间是精确选择将从 RRCIA 中受益的患者的预测因子。同时，RRCIA 后辅助治疗是提高生存率的重要因素。结论 本研究表明，RRCIA 似乎有效，并且与对全身治疗反应良好的 LAPC 患者的预后改善相关。LAPC 患者应至少接受 8 个周期的全身治疗和 CA19-9 正常化，以考虑进行 RRCIA。