Lee Mirang, Kang Jae Seung, Kim Hongbeom, Kwon Wooil, Lee Sang Hyub, Ryu Ji Kon, Kim Yong-Tae, Oh Do-Youn, Chie Eui Kyu, Jang Jin-Young
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Hepatobiliary Pancreat Sci. 2023 Jan;30(1):111-121. doi: 10.1002/jhbp.1050. Epub 2021 Oct 6.
Locally advanced (unresectable) pancreatic cancer (LAPC) is surgically unresectable and often treated with chemotherapy. Most previous studies, that have evaluated conversion surgery after chemotherapy, included heterogeneous patients and chemotherapy regimens, making it challenging to determine the impact of FOLFIRINOX. The present study evaluated the survival benefit of conversion surgery in patients with LAPC who received FOLFIRINOX chemotherapy, and analyzed the prognostic factors.
Patients with LAPC who received FOLFIRINOX as first-line therapy for at least four cycles were included. During chemotherapy, surgical eligibility was determined based on radiologic and metabolic response to the treatment. Clinicopathologic characteristics were compared between the curative-intent surgery and non-resection groups, and the prognostic factors were analyzed.
A total of 279 patients were included. The rates of partial response (PR) and stable disease (SD) were 34.1% and 51.4%, respectively, and 16.8% patients underwent curative-intent surgery. The median survival was significantly longer in the resection group than in the non-resection group (56 vs 21 months, P < .001). In a multivariate analysis, curative-intent surgery (HR 0.260; P < .001) was the most important factor.
Conversion surgery after FOLFIRINOX chemotherapy effectively rescues patients with LAPC. Patients without progression after FOLFIRINOX could be considered as potential candidates for conversion surgery.
局部进展期（不可切除）胰腺癌（LAPC）无法通过手术切除，通常采用化疗进行治疗。此前大多数评估化疗后转化手术的研究纳入的患者和化疗方案各不相同，这使得确定FOLFIRINOX方案的影响具有挑战性。本研究评估了接受FOLFIRINOX化疗的LAPC患者进行转化手术的生存获益，并分析了预后因素。
纳入接受FOLFIRINOX作为一线治疗至少四个周期的LAPC患者。在化疗期间，根据对治疗的放射学和代谢反应确定手术 eligibility。比较了根治性手术组和未切除组的临床病理特征，并分析了预后因素。
共纳入279例患者。部分缓解（PR）率和疾病稳定（SD）率分别为34.1%和51.4%，16.8%的患者接受了根治性手术。切除组的中位生存期显著长于未切除组（56个月对21个月，P <.001）。在多变量分析中，根治性手术（HR 0.260；P <.001）是最重要的因素。
FOLFIRINOX化疗后进行转化手术可有效挽救LAPC患者。FOLFIRINOX治疗后无进展的患者可被视为转化手术的潜在候选者。
