不可切除胰腺癌经 FOLFIRINOX 或吉西他滨加白蛋白紫杉醇治疗后的转化手术。

Conversion Surgery for Unresectable Pancreatic Cancer Treated With FOLFIRINOX or Gemcitabine Plus Nab-paclitaxel.

机构信息

Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan.

Department of Internal Medicine, National Hospital Organization Saga Hospital, Saga, Japan.

出版信息

Anticancer Res. 2023 Apr;43(4):1817-1826. doi: 10.21873/anticanres.16335.

DOI:10.21873/anticanres.16335

PMID:36974805

Abstract

BACKGROUND/AIM: Recent advances in chemotherapy have made significant progress in conversion surgery (CS) for unresectable pancreatic cancer (uPC). However, the success rate and efficacy of CS have not been fully demonstrated in patients with uPC treated with FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (GnP).

PATIENTS AND METHODS

We retrospectively reviewed the records of 318 patients with uPC who received FFX or GnP as first-line chemotherapy. The efficacy in the CS group, defined as undergoing complete resection after chemotherapy, was analyzed, and compared with the non-CS group; then, contributing factors to achieving CS were extracted. We also analyzed differences in the efficacy of CS between locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC).

RESULTS

Overall, CS was achieved in 4.3% of cases, eight patients (13.3%) with LAPC and five (2.1%) with MPC. Contributing factors to CS were LAPC, no liver metastasis, CA19-9 ≤37, and chemotherapy response. After adjusting for these, overall survival was significantly better in the CS group than in the non-CS group [median of 32.9 vs. 11.3 months; adjusted hazard ratio (HR)=0.32; 95% confidence interval (CI)=0.14-0.70; p<0.01]. Median relapse-free survival duration after CS was 19.1 and 18.1 months in the LAPC-CS and MPC-CS group, respectively (p=0.84). The median post-conversion survival was 27.6 months in the entire CS group, 43.8 months in the LAPC-CS group and 21.3 months in the MPC-CS group.

CONCLUSION

CS was achieved in 13.3% of LAPC and 2.1% of MPC cases. If possible, CS can markedly improve prognosis, even in MPC.

摘要

背景/目的：化疗的最新进展使无法切除的胰腺癌（uPC）的转化手术（CS）取得了重大进展。然而，在接受 FOLFIRINOX（FFX）或吉西他滨加 nab-紫杉醇（GnP）治疗的 uPC 患者中，CS 的成功率和疗效尚未得到充分证实。

患者和方法

我们回顾性分析了 318 例接受 FFX 或 GnP 一线化疗的 uPC 患者的病历。分析了 CS 组（定义为化疗后完全切除）的疗效，并与非 CS 组进行比较；然后，提取了实现 CS 的影响因素。我们还分析了局部晚期胰腺癌（LAPC）和转移性胰腺癌（MPC）CS 疗效的差异。

结果

总体而言，CS 的实现率为 4.3%，8 例（13.3%）LAPC 和 5 例（2.1%）MPC。CS 的影响因素为 LAPC、无肝转移、CA19-9≤37 和化疗反应。在调整这些因素后，CS 组的总生存期明显长于非 CS 组[中位 32.9 比 11.3 个月；调整后的风险比（HR）=0.32；95%置信区间（CI）=0.14-0.70；p<0.01]。LAPC-CS 和 MPC-CS 组 CS 后无复发生存期的中位时间分别为 19.1 和 18.1 个月（p=0.84）。整个 CS 组的中位转化后生存期为 27.6 个月，LAPC-CS 组为 43.8 个月，MPC-CS 组为 21.3 个月。