Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, UMC Utrecht Cancer Center, St Antonius Hospital Nieuwegein and Meander Medical Center Amersfoort, Regional Academic Cancer Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Ann Surg. 2021 Nov 1;274(5):729-735. doi: 10.1097/SLA.0000000000005120.
This study compared median OS after resection of LAPC after upfront FOLFIRINOX versus a propensity-score matched cohort of LAPC patients treated with FOLFIRINOX-only (ie, without resection).
Because the introduction of FOLFIRINOX chemotherapy, increased resection rates in LAPC patients have been reported, with improved OS. Some studies have also reported promising OS with FOLFIRINOX-only treatment in LAPC. Multicenter studies assessing the survival benefit associated with resection of LAPC versus patients treated with FOLFIRINOX-only are lacking.
Patients with non-progressive LAPC after 4 cycles of FOLFIRINOX treatment, both with and without resection, were included from a prospective multicenter cohort in 16 centers (April 2015-December 2019). Cox regression analysis identified predictors for OS. One-to-one propensity score matching (PSM) was used to obtain a matched cohort of patients with and without resection. These patients were compared for OS.
Overall, 293 patients with LAPC were included, of whom 89 underwent a resection. Resection was associated with improved OS (24 vs 15 months, P < 0.01), as compared to patients without resection. Before PSM, resection, Charlson Comorbidity Index, and Response Evaluation Criteria in Solid Tumors (RECIST) response were predictors for OS. After PSM, resection remained associated with improved OS [Hazard Ratio (HR) 0.344, 95% confidence interval (0.222-0.534), P < 0.01], with an OS of 24 versus 15 months, as compared to patients without resection. Resection of LAPC was associated with improved 3-year OS (31% vs 11%, P < 0.01).
Resection of LAPC after FOLFIRINOX was associated with increased OS and 3-year survival, as compared to propensity-score matched patients treated with FOLFIRINOX-only.
本研究比较了初始 FOLFIRINOX 治疗后接受 LAPC 切除术与仅接受 FOLFIRINOX 治疗（即未行切除术）的 LAPC 患者倾向性评分匹配队列的中位总生存期（OS）。
由于 FOLFIRINOX 化疗的引入，LAPC 患者的切除率有所增加，OS 得到改善。一些研究还报告了 LAPC 患者仅接受 FOLFIRINOX 治疗的有希望的 OS。缺乏评估 LAPC 切除术与仅接受 FOLFIRINOX 治疗的患者的生存获益的多中心研究。
从 16 个中心的前瞻性多中心队列中纳入了 4 个周期 FOLFIRINOX 治疗后非进展性 LAPC 的患者（有和无切除术）（2015 年 4 月至 2019 年 12 月）。Cox 回归分析确定了 OS 的预测因素。采用 1:1 倾向评分匹配（PSM）获得有和无切除术的匹配队列。比较这些患者的 OS。
总体而言，共纳入 293 例 LAPC 患者，其中 89 例行切除术。与未行切除术的患者相比，切除术与 OS 改善相关（24 个月 vs. 15 个月，P < 0.01）。在 PSM 之前，切除术、Charlson 合并症指数和实体瘤反应评价标准（RECIST）反应是 OS 的预测因素。PSM 后，切除术仍与 OS 改善相关（HR 0.344，95%置信区间 0.222-0.534，P < 0.01），与未行切除术的患者相比，OS 为 24 个月 vs. 15 个月。LAPC 切除术与 3 年 OS 改善相关（31% vs. 11%，P < 0.01）。
与仅接受 FOLFIRINOX 治疗的倾向评分匹配患者相比，FOLFIRINOX 后 LAPC 的切除术与 OS 和 3 年生存率的提高相关。
