CT引导下经皮不可逆电穿孔联合FOLFIRINOX化疗在局部晚期胰腺癌中的价值：一项事后比较
Value of CT-Guided Percutaneous Irreversible Electroporation Added to FOLFIRINOX Chemotherapy in Locally Advanced Pancreatic Cancer: A Post Hoc Comparison.
作者信息
van Veldhuisen Eran, Vroomen Laurien G, Ruarus Alette H, Derksen Tyche C, Busch Olivier R, de Jong Marcus C, Kazemier Geert, Puijk Robbert S, Sorgedrager Natasha S, Vogel Jantien A, Scheffer Hester J, van Lienden Krijn P, Wilmink Johanna W, Besselink Marc G, Meijerink Martijn R
机构信息
Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
出版信息
J Vasc Interv Radiol. 2020 Oct;31(10):1600-1608. doi: 10.1016/j.jvir.2020.02.024. Epub 2020 Aug 27.
PURPOSE
To compare survival after CT-guided percutaneous irreversible electroporation (IRE) and folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) chemotherapy versus FOLFIRINOX only in patients with locally advanced pancreatic cancer (LAPC).
MATERIALS AND METHODS
A post hoc comparison was performed of data derived from a prospective IRE-FOLFIRINOX cohort and a retrospective FOLFIRINOX-only cohort. All patients received a minimum of 3 cycles of FOLFIRINOX for LAPC and were considered eligible for CT-guided percutaneous IRE. Endpoints included overall survival (OS), local and distant progression-free survival, and time to progression (TTP) and were compared using stratified Kaplan-Meier analysis. Patients who received > 8 cycles of FOLFIRINOX before IRE and who had tumors > 6 cm in the FOLFIRINOX-only group were excluded.
RESULTS
Of 103 patients with a diagnosis of LAPC, 52 were deemed eligible (n = 30 IRE-FOLFIRINOX and n = 22 FOLFIRINOX-only). Patients in the FOLFIRINOX-only arm had larger tumors (53 mm ± 19 vs 38 mm ± 7, P = .340), had more locoregional lymph node metastases (23% vs 7%, P = .622), and more often received radiotherapy (7 patients vs 2 patients, P = .027); all other baseline characteristics were comparable. Median OS was 17.0 months (range, 5-35 mo; SD = 6) for IRE-FOLFIRINOX versus 12.4 months (range, 3-22 mo; SD = 6) for FOLFIRINOX-only (P = .038). After sensitivity analyses, median OS was 17.2 months (range, 6-27 mo; SD = 6) versus 12.4 months (range, 7-32 mo; SD = 10) (P = .05). Median TTP was longer in the IRE-FOLFIRINOX group: 14.2 months (range, 5-25 mo; SD = 4) versus 5.2 months (range, 2-22; SD = 6) (P = .0001).
CONCLUSIONS
In patients with LAPC after FOLFIRINOX chemotherapy, CT-guided percutaneous IRE may improve OS and TTP. This study may facilitate the design of randomized controlled trials to compare survival after IRE-FOLRINOX versus FOLFIRINOX-only.
目的
比较在局部晚期胰腺癌（LAPC）患者中，CT引导下经皮不可逆电穿孔（IRE）联合亚叶酸、氟尿嘧啶、伊立替康和奥沙利铂（FOLFIRINOX）化疗与单纯FOLFIRINOX化疗后的生存率。
材料与方法
对来自前瞻性IRE-FOLFIRINOX队列和回顾性单纯FOLFIRINOX队列的数据进行事后比较。所有患者均接受至少3个周期的FOLFIRINOX治疗LAPC，且被认为适合CT引导下经皮IRE治疗。观察终点包括总生存期（OS）、局部和远处无进展生存期以及进展时间（TTP），并使用分层Kaplan-Meier分析进行比较。排除在IRE治疗前接受超过8个周期FOLFIRINOX治疗以及单纯FOLFIRINOX组中肿瘤直径>6 cm的患者。
结果
在103例诊断为LAPC的患者中，52例被认为符合条件（n = 30例IRE-FOLFIRINOX和n = 22例单纯FOLFIRINOX）。单纯FOLFIRINOX组的患者肿瘤更大（53 mm±19 vs 38 mm±7，P = 0.340），有更多的局部区域淋巴结转移（23% vs 7%，P = 0.622），且更常接受放疗（7例患者vs 2例患者，P = 0.027）；所有其他基线特征具有可比性。IRE-FOLFIRINOX组的中位OS为17.0个月（范围5 - 35个月；标准差 = 6），而单纯FOLFIRINOX组为12.4个月（范围3 - 22个月；标准差 = 6）（P = 0.038）。经过敏感性分析后，中位OS为17.2个月（范围6 - 27个月；标准差 = 6）对比12.4个月（范围7 - 32个月；标准差 = 10）（P = 0.05）。IRE-FOLFIRINOX组的中位TTP更长：14.2个月（范围5 - 25个月；标准差 = 4）对比5.2个月（范围2 - 22个月；标准差 = 6）（P = 0.0001）。
结论
在接受FOLFIRINOX化疗后的LAPC患者中，CT引导下经皮IRE可能改善OS和TTP。本研究可能有助于设计随机对照试验，以比较IRE-FOLRINOX与单纯FOLFIRINOX后的生存率。
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