Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Gut Liver. 2021 May 15;15(3):466-475. doi: 10.5009/gnl20070.
BACKGROUND/AIMS: Although many studies have reported the promising effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC) to increase resectability, only a few studies have recommended the use of first-line chemotherapeutic agents as neoadjuvant treatment for BRPC. The current study compared clinical outcomes between gemcitabine and FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) in patients with BRPC.
In this single-center retrospective study, 100 BRPC patients treated with neoadjuvant chemotherapy and resection from 2008 to 2018 were reviewed. Clinical outcomes included overall survival, resectability, and recurrence patterns after gemcitabine or FOLFIRINOX treatment.
For neoadjuvant chemotherapy, gemcitabine was administered to 34 patients and FOLFIRINOX to 66. Neoadjuvant radiotherapy was administered to 27 patients (79.4%) treated with gemcitabine and 19 (28.8%) treated with FOLFIRINOX (p<0.001). The 2- and 5-year survival rates (YSRs) were significantly higher after FOLFIRINOX (2YSR, 72.2%; 5YSR, 46.0%) than after gemcitabine (2YSR, 58.4%; 5YSR, 19.1%; p=0.041). The margin negative rate was comparable (gemcitabine, 94.1%; FOLFIRINOX, 92.4%; p=0.753), and the tumor size change in percentage showed only a marginal difference (gemcitabine, 20.5%; FOLFIRINOX, 29.0%; p=0.069). Notably, the metastatic recurrence rate was significantly lower in the FOLFIRINOX group (n=20, 52.6%) than in the gemcitabine group (n=22, 78.6%; p=0.001). The rate of adverse events after chemotherapy was significantly higher with FOLFIRINOX than with gemcitabine (43.9%, 20.6%, respectively; p=0.037).
FOLFIRINOX provided more clinical and oncological benefit than gemcitabine, with significantly higher overall survival and lower cumulative recurrence rates in BRPC. However, since FOLFIRINOX causes more adverse effects, the regimen should be individualized based on patient's general condition and clinical status.
背景/目的：虽然许多研究报告了新辅助治疗交界可切除胰腺癌（BRPC）以提高可切除性的有希望的效果，但只有少数研究推荐将一线化疗药物作为 BRPC 的新辅助治疗。本研究比较了吉西他滨和 FOLFIRINOX（氟尿嘧啶、亚叶酸钙、奥沙利铂和伊立替康）在 BRPC 患者中的临床疗效。
在这项单中心回顾性研究中，回顾了 2008 年至 2018 年间接受新辅助化疗和切除术的 100 例 BRPC 患者。临床结局包括总生存期、可切除性和吉西他滨或 FOLFIRINOX 治疗后的复发模式。
新辅助化疗中，34 例患者接受吉西他滨治疗，66 例患者接受 FOLFIRINOX 治疗。27 例（79.4%）接受吉西他滨治疗和 19 例（28.8%）接受 FOLFIRINOX 治疗的患者接受了新辅助放疗（p<0.001）。FOLFIRINOX 组的 2 年和 5 年生存率（YSR）明显高于吉西他滨组（2YSR，72.2%；5YSR，46.0%）（p=0.041）。阴性切缘率相当（吉西他滨，94.1%；FOLFIRINOX，92.4%；p=0.753），肿瘤大小变化百分比仅略有差异（吉西他滨，20.5%；FOLFIRINOX，29.0%；p=0.069）。值得注意的是，FOLFIRINOX 组的转移性复发率明显低于吉西他滨组（n=20，52.6%）与吉西他滨组（n=22，78.6%）（p=0.001）。FOLFIRINOX 组化疗后不良事件发生率明显高于吉西他滨组（分别为 43.9%和 20.6%）（p=0.037）。
与吉西他滨相比，FOLFIRINOX 提供了更多的临床和肿瘤学获益，在 BRPC 中总生存率更高，累积复发率更低。然而，由于 FOLFIRINOX 引起更多的不良反应，该方案应根据患者的一般状况和临床状况进行个体化。
