Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA, 02114-3117, USA.
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Gastrointest Surg. 2021 Nov;25(11):2859-2870. doi: 10.1007/s11605-020-04897-9. Epub 2021 Jan 26.
Dynamic survival data based on time already survived are lacking for resected borderline resectable/locally advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC) patients who received total neoadjuvant therapy (TNT) with FOLFIRINOX followed by chemoradiation. Conditional survival, i.e., the probability of surviving an additional length of time after having already survived an amount of time, offers such information. We aimed to determine actuarial and conditional overall (OS, COS) and disease-free survival (DFS, CDFS) among this cohort.
Clinicopathologic data were retrospectively collected for resected BR/LA PDAC patients who received TNT (2011-2019). COS and CDFS rates were calculated for patients being event (death/recurrence)-free at multiple intervals and by recurrence status.
After a median follow-up of 32.1 months, the 183 patients had a median OS and DFS of 39.1 months and 16.8 months, respectively. COS and CDFS increased as a function of time already survived. The probability of surviving an additional 24 months if a patient survived 2 years post-operatively was 70%, whereas the 4-year actuarial OS was 47%. Similarly, the probability of surviving disease-free an additional 24 months after 2 years was 66%, while actuarial 48-month DFS was 27%. COS for disease-free patients increased further over time. For patients remaining disease-free 12 months post-operatively, BR vs. LA status at diagnosis, tumor ≤ 4 cm at diagnosis, and R0 resection were independent predictors of favorable additional OS and DFS.
For resected TNT-treated BR/LA PDAC patients, the probability of surviving an additional length of time increases as a function of survival already accrued. Dynamic survival estimates may allow personalized follow-up and counseling.
对于接受 FOLFIRINOX 新辅助化疗后联合放化疗的完全切除边界可切除/局部进展期（BR/LA）胰腺导管腺癌（PDAC）患者，缺乏基于已生存时间的动态生存数据。条件生存，即已经生存一段时间后再生存额外一段时间的概率，提供了此类信息。我们旨在确定该队列的总生存（OS，COS）和无病生存（DFS，CDFS）的实际和条件。
回顾性收集了接受新辅助化疗（2011-2019 年）的完全切除 BR/LA PDAC 患者的临床病理数据。根据无事件（死亡/复发）状态和复发状态，计算患者在多个时间间隔的 COS 和 CDFS 率。
中位随访 32.1 个月后，183 例患者的中位 OS 和 DFS 分别为 39.1 个月和 16.8 个月。COS 和 CDFS 随已生存时间的增加而增加。如果患者在手术后 2 年内存活，那么再存活 24 个月的概率为 70%，而 4 年实际 OS 为 47%。同样，在 2 年内无病生存再增加 24 个月的概率为 66%，而 48 个月的实际 DFS 为 27%。无病患者的 COS 随着时间的推移进一步增加。对于手术后 12 个月无病的患者，BR 与 LA 状态、诊断时肿瘤≤4cm 和 R0 切除是额外 OS 和 DFS 的独立预测因素。
对于接受新辅助化疗治疗的完全切除的 BR/LA PDAC 患者，随着已生存时间的增加，再生存的概率增加。动态生存估计可能允许进行个性化随访和咨询。
