Effect Of Neoadjuvant Chemotherapy On Short-term Clinical Outcome And Long-term Prognosis In Patients With Locally Advanced Pancreatic Cancer

Objective The purpose of our research is to evaluate the effect of neoadjuvant chemotherapy on the short-term clinical outcome and long-term prognosis of LAPC patients.With that,we can provide data and evidence support for the selection of neoadjuvant chemotherapy regimen for LAPC patients.Methods We retrospectively analyzed the clinical data of LAPC patients in Qilu Hospital of Shandong University from May 2015 to December 2020,and selected 43 patients in the neoadjuvant chemotherapy group and 24 patients in the chemotherapy group according to inclusion and exclusion criteria.We analyzed the clinical data of the neoadjuvant chemotherapy group,including surgical conversion rate,incidence of surgical complications,and 1-year survival rate,and then evaluated the clinical efficacy of neoadjuvant chemotherapy combined with literature.The patients in the neoadjuvant chemotherapy group were divided into two subgroups:no surgical resection(35 cases)and surgical resection(8 cases).The data of those two subgroups were compared with those in the chemotherapy group respectively to discuss the advantages and disadvantages of neoadjuvant chemotherapy.In addition,the clinical data of patients with different chemotherapy regimens in the neoadjuvant chemotherapy group were compared and analyzed,to provide research data and evidence support for the selection of neoadjuvant chemotherapy.Results1.The ORR of LAPC patients after neoadjuvant chemotherapy was 4.65%,the DCR was 65.2%,the pain relief rate was 74.4%,the total surgical conversion rate was 18.6%,the R0 surgical conversion rate was 11.6%and the OS was 15.36±0.89 months.2.In the neoadjuvant chemotherapy group,there was No significant difference in overall survival time between the surgical resection subgroup and the non-surgical subgroup(P=0.051).In the neoadjuvant chemotherapy group,The subgroup without surgical resection was superior to the chemotherapy group in the half-year survival rate and 1-year survival rate,but there was no significant difference in overall survival time(P=0.597).The subgroup with surgical resection was superior to the chemotherapy group in the half-year survival rate and 1-year survival rate,but there was no significant difference in overall survival time(P=0.127).3.Of the 12 patients with the GS regimen,3 patients underwent surgery,including 2 R0 resections and 1 R1 resection,with a surgical conversion rate of 25%.Of the 16 patients with AG regimen,3 patients underwent surgery,were all R0 resections,with the surgical conversion rate was 18.75%.There were 13 patients with AS regimen,1 case underwent surgery,it was R2 resection,and the surgical conversion rate was 7.7%.There were 2 patients with FORFIRINOX regimen,and 1 patient underwent surgery,which was R1 resection.There was no significant difference in surgical conversion rate,DCR,and 1-year survival rate between the GS regimen and the AG regimen,and they were better than the AS regimen.In terms of overall survival time,the AG regimen was better than the AS regimen(P=0.027),the GS regimen was better than the AS regimen(P=0.045),and there was no statistical difference between the AG regimen and the GS regimen(P=0.724).Conclusion For LAPC patients,neoadjuvant chemotherapy is recommended for treatment.And the 1-year survival rate of patients undergoing surgical resection after neoadjuvant chemotherapy was significantly better than that of patients in the chemotherapy group.For patients who failed to undergo surgery after neoadjuvant chemotherapy,there was no significant difference in pain relief,chemotherapy side effects,and overall survival time from those in the chemotherapy group.Therefore,neoadjuvant chemotherapy for LAPC is worthy of promotion in clinical practice.