Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands; Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands.
Eur J Surg Oncol. 2021 Mar;47(3 Pt B):699-707. doi: 10.1016/j.ejso.2020.11.137. Epub 2020 Nov 26.
Since current studies on locally advanced pancreatic cancer (LAPC) mainly report from single, high-volume centers, it is unclear if outcomes can be translated to daily clinical practice. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC.
Consecutive patients with LAPC according to Dutch Pancreatic Cancer Group criteria, were prospectively included in 14 centers from April 2015 until December 2017. A centralized expert panel reviewed response according to RECIST v1.1 and potential surgical resectability. Primary outcome was median overall survival (mOS), stratified for primary treatment strategy.
Overall, 422 patients were included, of whom 77% (n = 326) received chemotherapy. The majority started with FOLFIRINOX (77%, 252/326) with a median of six cycles (IQR 4-10). Gemcitabine monotherapy was given to 13% (41/326) of patients and nab-paclitaxel/gemcitabine to 10% (33/326), with a median of two (IQR 3-5) and three (IQR 3-5) cycles respectively. The mOS of the entire cohort was 10 months (95%CI 9-11). In patients treated with FOLFIRINOX, gemcitabine monotherapy, or nab-paclitaxel/gemcitabine, mOS was 14 (95%CI 13-15), 9 (95%CI 8-10), and 9 months (95%CI 8-10), respectively. A resection was performed in 13% (32/252) of patients after FOLFIRINOX, resulting in a mOS of 23 months (95%CI 12-34).
This multicenter unselected cohort of patients with LAPC resulted in a 14 month mOS and a 13% resection rate after FOLFIRINOX. These data put previous results in perspective, enable us to inform patients with more accurate survival numbers and will support decision-making in clinical practice.
由于目前关于局部晚期胰腺癌（LAPC）的研究主要来自单一、高容量的中心，因此尚不清楚这些结果是否可以转化为日常临床实践。本研究提供了在一个多中心、未经选择的 LAPC 患者队列中使用的治疗策略和临床结果。
根据荷兰胰腺癌症组的标准，连续的 LAPC 患者于 2015 年 4 月至 2017 年 12 月期间被前瞻性地纳入 14 个中心。一个集中的专家小组根据 RECIST v1.1 标准对反应进行了评估，并评估了潜在的手术可切除性。主要结局是根据主要治疗策略分层的中位总生存期（mOS）。
总体而言，共纳入 422 例患者，其中 77%（n=326）接受了化疗。大多数患者开始使用 FOLFIRINOX（77%，252/326），中位数为 6 个周期（IQR 4-10）。吉西他滨单药治疗的患者占 13%（41/326），nab-紫杉醇/吉西他滨治疗的患者占 10%（33/326），中位数分别为 2（IQR 3-5）和 3 个周期（IQR 3-5）。整个队列的 mOS 为 10 个月（95%CI 9-11）。在接受 FOLFIRINOX、吉西他滨单药治疗或 nab-紫杉醇/吉西他滨治疗的患者中，mOS 分别为 14 个月（95%CI 13-15）、9 个月（95%CI 8-10）和 9 个月（95%CI 8-10）。FOLFIRINOX 治疗后，13%（32/252）的患者接受了手术切除，mOS 为 23 个月（95%CI 12-34）。
本研究为多中心未经选择的 LAPC 患者队列提供了 14 个月的 mOS 和 13%的 FOLFIRINOX 后切除率。这些数据使以前的结果更加具体，并使我们能够为患者提供更准确的生存数据，为临床实践中的决策提供支持。
