Mita Naoki, Iwashita Takuji, Ichikawa Hironao, Iwasa Yuhei, Uemura Shinya, Murase Katsutoshi, Shimizu Masahito
First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan.
Department of Digestive Surgery, Gifu University Hospital, Gifu 501-1194, Japan.
J Clin Med. 2021 Jun 27;10(13):2848. doi: 10.3390/jcm10132848.
Pancreatic cancer is one of the most lethal cancers. To improve its prognosis, conversion surgery for initially unresectable advanced pancreatic cancer (UAPC) after chemotherapy has been reported in recent years.
A retrospective analysis of the patients with initially UAPC underwent conversion surgery after the first-line modified FOLFIRINOX (mFX) was conducted at a single tertiary care center between January 2014 and March 2020.
Among 79 patients with UAPC who had mFX, 8 patients with a median age of 63 years, including 5 males (3 with locally advanced and 5 metastatic lesions), underwent conversion surgery after a median of 20 cycles of mFX. Conversion surgery was performed in 10.1% of patients (8/79) and surgical resection was successful in all with R0 resection. Postoperative major adverse events were seen in 2 patients, but no perioperative deaths were recognized. Recurrence was confirmed in 3 patients, and these 3 patients died due to cancer recurrence in 17.7, 30.6 and 57.8 months after mFX initiation. 5 patients were still alive without recurrence. The median OS in the patients who underwent conversion surgery was estimated as 65.9 months and was significantly longer than that of the patients without conversion surgery or that in the patients who had a partial response for mFX but did not have conversion surgery. The median follow-up period for the patients who had conversion surgery was 35.2 months.
Conversion surgery achieved long-term survival in patients with UAPC who were treated with the first-line mFX, although controversy still remained.
胰腺癌是最致命的癌症之一。为改善其预后，近年来已有关于对初始不可切除的晚期胰腺癌（UAPC）化疗后进行转化手术的报道。
对2014年1月至2020年3月期间在一家三级医疗中心接受一线改良FOLFIRINOX（mFX）治疗后进行转化手术的初始UAPC患者进行回顾性分析。
在79例接受mFX治疗的UAPC患者中，8例患者（中位年龄63岁，包括5例男性，其中3例为局部晚期病变，5例为转移病变）在接受中位20个周期的mFX治疗后进行了转化手术。10.1%的患者（8/79）接受了转化手术，所有患者手术切除均成功，切缘阴性（R0切除）。2例患者出现术后严重不良事件，但未发生围手术期死亡。3例患者复发，这3例患者在开始mFX治疗后17.7、30.6和57.8个月因癌症复发死亡。5例患者仍存活且无复发。接受转化手术患者的中位总生存期估计为65.9个月，显著长于未接受转化手术的患者或对mFX有部分缓解但未接受转化手术的患者。接受转化手术患者的中位随访期为35.2个月。
尽管仍存在争议，但转化手术使接受一线mFX治疗的UAPC患者获得了长期生存。
