研究使用多种诊断方法进行综合预治疗分期，包括功能性影像和微创手术程序，对局部晚期胰腺癌（LAPC）患者进行调查。首要目标是使用分期腹腔镜检查和18FFDG-PET/CT扫描检测隐匿性转移疾病。该研究还评估了联合治疗对LAPC患者的疗效和预后。本研究是对化疗放疗（CRT）和/或诱导化疗（IC）三项前瞻性研究的次要分析。纳入期限为2009年12月至2023年2月。所有LAPC患者进行了加强型预治疗分期。初步分期时没有远处疾病的患者，患有边缘可切除或不可切除的LAPC，被纳入化疗放疗联合方案（CRT with or without IC）。IC方案包括GemOx或FOLFIRINOX，共进行四个周期，然后与吉西他滨联合进行放疗。主要终点是检测隐匿性转移疾病，次要目标包括切除率、治疗毒性、总生存期（OS）、无进展生存期（PFS）、局部控制（LC）和无转移生存期（MFS）。在134例LAPC患者中，33.5%发现有转移性疾病。其中，23.1%经探查性腹腔镜检查呈阳性。此外，18-FDG PET/CT检查发现13.4%存在远处转移。完成CRT的所有患者的中位PFS为14.3个月，中位OS为17.2个月。经过联合治疗后切除的患者与非切除患者相比，疗效显著改善（中位PFS为22.5个月vs. 9.5个月，P<0.001；中位OS为38.2个月vs. 13个月，P<0.001）。此外，经过IC后接受CRT的患者与先行CRT组相比，疗效显著更好（中位PFS为19个月vs. 9.9个月，P<0.001；中位OS为19.3个月vs. 14.6个月，P<0.001）。在单因素logistic回归分析中，IC的添加是切除率的唯一预测因子（95% CI 0.12-1.02，P=0.05），这一数据在多因素分析中得到了证实（95% CI 0.09-0.98，P=0.04）。在治疗过程中观察到了血液和胃肠道毒性反应，并可控制不良事件。综合预治疗，包括腹腔镜检查和18F-FDG-PET/CT扫描的使用，是确定LAPC患者隐匿性转移疾病的有效方法。我们的研究结果为准确分期和治疗效果提供了有价值的见解，并为LAPC患者的最佳管理策略提供了基于证据的支持。版权所有 © 2023作者。由Wolters Kluwer Health, Inc.出版。

To investigate the use of comprehensive pre-treatment staging with multiple diagnostic modalities, including functional imaging and minimally invasive surgical procedures, in locally advanced pancreatic cancer (LAPC) patients. The primary objective was to detect occult metastatic disease using staging laparoscopy and 18FFDG-PET/CT scan. The study also evaluated treatment efficacy and outcomes in LAPC patients treated with combined therapies.This study was a secondary analysis of three prospective studies of chemoradiotherapy (CRT) with or without induction chemotherapy (IC). The inclusion period was from December 2009 until February 2023. An intensified pretreatment staging was conducted for all LAPC patients. Patients without distant disease at initial staging, with borderline resectable or unresectable LAPC, were enrolled in chemoradiotherapy combination protocols (CRT with or without IC). IC regimens included GemOx or FOLFIRINOX for four cycles, followed by concurrent CRT with gemcitabine. The primary endpoint was the detection of occult metastatic disease, and secondary objectives included resection rate, treatment toxicity, overall survival (OS), progression-free survival (PFS), local control (LC), and metastasis-free survival (MFS).Out of the 134 LAPC patients, 33.5% were identified with metastatic disease. Of these, 23.1% had a positive exploratory laparoscopy. Additionally, 13.4% were identified as having distant metastases by 18-FDG PET/CT. The median PFS for all patients who completed CRT was 14.3 months, and the median OS was 17.2 months. Resected patients after the combined therapies demonstrated significantly improved outcomes compared to non-resected patients (median PFS, 22.5 mo vs. 9.5 mo, P<0.001; median OS, 38.2 mo vs. 13 mo, P<0.001). Moreover, patients treated with IC followed by CRT showed significantly better outcomes compared to upfront CRT group (median PFS, 19 mo vs. 9.9 mo, P<0.001; median OS, 19.3 mo vs. 14.6 mo, P<0.001). At univariate logistic regression analysis, the adding of IC was the only predictor for resection rate (95% CI 0.12-1.02, P=0.05), and this data was confirmed at multivariate analysis (95% CI 0.09-0.98, P=0.04). Haematological and gastrointestinal toxicities were observed during treatment, with manageable adverse events.The use of comprehensive pre-treatment staging, including laparoscopy and 18F-FDG-PET/CT scan, is an effective approach in identifying occult metastatic disease in LAPC patients. Our findings offer valuable insights into accurate staging and treatment efficacy, providing evidence-based support for optimal management strategies in LAPC patients.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.