Park Jaewoo, Kim Hae Young, Na Hee Young, Lee Jun Suh, Lee Jong-Chan, Kim Jin Won, Yoon Yoo-Seok, Hwang Jin-Hyeok, Han Ho-Seong, Kim Jaihwan
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Songnam, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Songnam, Korea.
J Cancer Res Clin Oncol. 2023 May;149(5):1765-1775. doi: 10.1007/s00432-022-04108-9. Epub 2022 Jun 20.
We aimed to assess the role of adjuvant FOLFIRINOX, in comparison with other adjuvant therapy, in patients who received neoadjuvant FOLFIRINOX and surgery for borderline resectable or locally advanced pancreatic cancer (BRPC or LAPC).
Our target population was patients with BRPC or LAPC, who received adjuvant therapy following neoadjuvant FOLFIRINOX and surgery between June 2013 and October 2020. Multivariable Cox proportional-hazard model was used to identify factors associated with overall survival (OS) and recurrence free survival (RFS).
Among 244 patients with BRPC or LAPC who received neoadjuvant FOLFIRINOX, 79 patients underwent subsequent surgery. Among them, 58 who received adjuvant therapy [median age, 63 years; 33 females (56.9%)] were included. Thirty patients received adjuvant modified FOLFIRINOX (mFOLFIRINOX), while 28 received adjuvant therapy other than FOLFIRINOX. In multivariable analysis, mFOLFIRINOX and post-treatment carbohydrate antigen 19-9 (CA 19-9) were significantly associated with OS and RFS. According to mFOLFIRINOX vs. other adjuvant therapy, median OS was not reached at 37.5 months of follow-up vs. 29.7 months (P = .012); and median RFS was 30.5 vs. 11.0 months (P = .028). According to post-treatment CA 19-9 (< 37 vs. ≥ 37 U/mL), median OS was 46.0 vs. 25.5 months (P = .022); and median RFS was 25.9 vs. 7.6 months (P = .012).
Continued adjuvant mFOLFIRINOX and post-treatment CA 19-9 level were associated with survival in patients with BRPC or LAPC who received neoadjuvant FOLFIRINOX and surgery. Continued adjuvant mFOLFIRINOX after neoadjuvant FOLFIRINOX could be considered for patients with good performance.
我们旨在评估辅助性FOLFIRINOX方案相较于其他辅助治疗方案，在接受新辅助FOLFIRINOX方案及手术治疗的临界可切除或局部晚期胰腺癌（BRPC或LAPC）患者中的作用。
我们的目标人群为2013年6月至2020年10月期间接受新辅助FOLFIRINOX方案及手术治疗后接受辅助治疗的BRPC或LAPC患者。采用多变量Cox比例风险模型来确定与总生存期（OS）和无复发生存期（RFS）相关的因素。
在244例接受新辅助FOLFIRINOX方案的BRPC或LAPC患者中，79例接受了后续手术。其中，58例接受了辅助治疗的患者[中位年龄63岁；33例女性（56.9%）]被纳入研究。30例患者接受了辅助性改良FOLFIRINOX方案（mFOLFIRINOX），而28例接受了FOLFIRINOX以外的辅助治疗。在多变量分析中，mFOLFIRINOX方案及治疗后糖类抗原19-9（CA 19-9）水平与OS和RFS显著相关。根据mFOLFIRINOX方案与其他辅助治疗方案比较，随访37.5个月时OS未达到中位生存期，而其他辅助治疗组为29.7个月（P = 0.012）；中位RFS分别为30.5个月和11.0个月（P = 0.028）。根据治疗后CA 19-9水平（< 37 vs.≥37 U/mL）比较，中位OS分别为46.0个月和25.5个月（P = 0.022）；中位RFS分别为25.9个月和7.6个月（P = 0.012）。
对于接受新辅助FOLFIRINOX方案及手术治疗的BRPC或LAPC患者，持续辅助性mFOLFIRINOX方案及治疗后CA 19-9水平与生存相关。对于身体状况良好的患者，新辅助FOLFIRINOX方案后可考虑继续采用辅助性mFOLFIRINOX方案。
