单中心经验：诱导 5-氟尿嘧啶、亚叶酸、伊立替康和奥沙利铂联合手术对比巩固性放疗治疗局部进展期不可切除的交界性和局部进展期胰腺癌。

A Single-Institution Experience of Induction 5-Fluorouracil, Leucovorin, Irinotecan, and Oxaliplatin Followed by Surgery Versus Consolidative Radiation for Borderline and Locally Advanced Unresectable Pancreatic Cancer.

机构信息

From the Departments of Internal Medicine (Medical Oncology).

Therapeutic Radiology.

出版信息

Pancreas. 2020 Aug;49(7):904-911. doi: 10.1097/MPA.0000000000001592.

DOI:10.1097/MPA.0000000000001592

PMID:32658074

Abstract

OBJECTIVES

In the 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) era, the benefit of surgery versus definitive radiation for borderline resectable (BR) and locally advanced (LA) unresectable pancreatic ductal adenocarcinoma (PDAC) is not well defined. Our primary objective was to identify the survival impact of surgery for BR and LA unresectable PDAC treated with induction FOLFIRINOX.

METHODS

We performed a single-center retrospective review of BR and LA PDAC treated with FOLFIRINOX from 2010 to 2018. The overall survival of surgery and consolidative radiotherapy was estimated in the Kaplan-Meier method and compared via the log-rank test. Subgroup analyses were conducted for BR and LA patients.

RESULTS

We identified 101 BR and LA PDAC patients treated with induction FOLFIRINOX (41 surgeries and 60 consolidative radiotherapies). Surgery patients were 68.3% (28/41) BR and 31.7% (13/41) LA, whereas consolidative radiotherapy patients were 30% (18/60) BR and 70% (42/60) LA. The R0 resection rate was 100%, and 46.3% (19/41) received preoperative radiation. Median overall survival of surgery versus consolidative radiotherapy was 42.3 versus 19.6 months, respectively (P < 0.001). On multivariate analysis, surgery associated with improved survival.

CONCLUSIONS

Surgery after induction FOLFIRINOX is feasible and has a clinically meaningful survival benefit in BR and LA PDAC.

摘要

目的

在氟尿嘧啶、亚叶酸钙、伊立替康和奥沙利铂（FOLFIRINOX）时代，对于局部不可切除的边界可切除（BR）和局部晚期（LA）不可切除的胰腺导管腺癌（PDAC），手术与确定性放疗的获益尚不清楚。我们的主要目的是确定接受诱导 FOLFIRINOX 治疗的 BR 和 LA 不可切除 PDAC 患者接受手术的生存影响。

方法

我们对 2010 年至 2018 年接受 FOLFIRINOX 治疗的 BR 和 LA PDAC 患者进行了单中心回顾性研究。使用 Kaplan-Meier 方法估计手术和巩固性放疗的总生存率，并通过对数秩检验进行比较。对 BR 和 LA 患者进行了亚组分析。

结果

我们确定了 101 例接受诱导 FOLFIRINOX 治疗的 BR 和 LA PDAC 患者（41 例手术和 60 例巩固性放疗）。手术患者中 BR 占 68.3%（28/41），LA 占 31.7%（13/41），而巩固性放疗患者中 BR 占 30%（18/60），LA 占 70%（42/60）。R0 切除率为 100%，46.3%（19/41）患者接受了术前放疗。手术与巩固性放疗的中位总生存率分别为 42.3 个月和 19.6 个月（P<0.001）。多变量分析显示，手术与生存改善相关。