FOLFIRINOX 对比吉西他滨/白蛋白紫杉醇用于可切除和交界可切除胰头腺癌的新辅助治疗。
FOLFIRINOX Versus Gemcitabine/Nab-Paclitaxel for Neoadjuvant Treatment of Resectable and Borderline Resectable Pancreatic Head Adenocarcinoma.
机构信息
Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.
Department of Biostatistics and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Ann Surg Oncol. 2018 Jul;25(7):1896-1903. doi: 10.1245/s10434-018-6512-8. Epub 2018 May 14.
BACKGROUND
Both FOLFIRINOX and gemcitabine/nab-paclitaxel (G-nP) are used increasingly in the neoadjuvant treatment (NAT) of pancreatic ductal adenocarcinoma (PDA). This study aimed to compare neoadjuvant FOLFIRINOX and G-nP in the treatment of resectable (R) and borderline resectable (BR) head PDA.
METHODS
A single-institution retrospective review of R and BR patients undergoing pancreaticoduodenectomy after NAT with FOLFIRINOX or G-nP was performed. Comparative analysis was performed using inverse-probability-weighted (IPW) estimators. The end points of the study were overall survival (OS) and an 80% reduction in CA19-9 with NAT.
RESULTS
In this study, 193 patients were analyzed, with 73 patients receiving FOLFIRINOX and 120 patients receiving G-nP. The median OS was 38.7 months for FOLFIRINOX versus 28.6 months for G-nP (p = 0.214). The patients who received FOLFIRINOX were younger and had fewer comorbidities, more BR disease, and larger tumors than those treated with G-nP (all p < 0.05). The two regimens were equally effective in achieving an 80% decline in CA19-9 (p = 0.8). The R0 resection rates were similar (80%), but FOLFIRINOX was associated with a reduction in pN1 disease (56% vs. 72%; p = 0.028). The receipt of adjuvant therapy was similar (74 vs. 75%; p = 0.79). In the Cox regression analysis with adjustment for baseline and treatment-related variables (FOLFIRINOX vs. G-nP, age, gender, computed tomography (CT) tumor size, BR vs. R, pre-NAT CA19-9), regimen type was not associated with a survival benefit. In the IPW analysis of 166 patients, however, the average treatment effect of FOLFIRINOX was to increase OS by 4.9 months compared with G-nP (p = 0.012).
CONCLUSIONS
Both FOLFIRINOX and G-nP are viable options for neoadjuvant treatment of PDA. In this study, neoadjuvant FOLFIRINOX was associated with a 4.9-month improvement in survival compared with G-nP after adjustment for covariates.
背景
FOLFIRINOX 和吉西他滨/白蛋白紫杉醇（G-nP）都越来越多地用于胰腺导管腺癌（PDA）的新辅助治疗（NAT）。本研究旨在比较新辅助 FOLFIRINOX 和 G-nP 在可切除（R）和边界可切除（BR）胰头 PDA 中的治疗效果。
方法
对接受 FOLFIRINOX 或 G-nP 新辅助治疗后行胰十二指肠切除术的 R 和 BR 患者进行单中心回顾性分析。使用逆概率加权（IPW）估计器进行对比分析。本研究的终点是总生存期（OS）和 NAT 后 CA19-9 降低 80%。
结果
本研究共分析了 193 例患者，其中 73 例患者接受 FOLFIRINOX 治疗，120 例患者接受 G-nP 治疗。FOLFIRINOX 组的中位 OS 为 38.7 个月，G-nP 组为 28.6 个月（p=0.214）。接受 FOLFIRINOX 治疗的患者比接受 G-nP 治疗的患者年龄更小，合并症更少，BR 疾病更多，肿瘤更大（均 p<0.05）。两种方案在实现 CA19-9 降低 80%方面同样有效（p=0.8）。R0 切除率相似（80%），但 FOLFIRINOX 与减少 pN1 疾病相关（56% vs. 72%；p=0.028）。辅助治疗的接受率相似（74% vs. 75%；p=0.79）。在调整基线和治疗相关变量（FOLFIRINOX vs. G-nP、年龄、性别、CT 肿瘤大小、BR vs. R、NAT 前 CA19-9）的 Cox 回归分析中，方案类型与生存获益无关。然而，在 166 例患者的 IPW 分析中，与 G-nP 相比，FOLFIRINOX 的平均治疗效果使 OS 增加 4.9 个月（p=0.012）。
结论
FOLFIRINOX 和 G-nP 都是胰腺导管腺癌新辅助治疗的可行选择。在本研究中，在调整协变量后，与 G-nP 相比，新辅助 FOLFIRINOX 使 OS 改善了 4.9 个月。
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