Waugh Evelyn, Glinka Juan, Breadner Daniel, Liu Rachel, Tang Ephraim, Allen Laura, Welch Stephen, Leslie Ken, Skaro Anton
Division of General Surgery, Department of Surgery, Western University, London, ON, Canada.
Division of Medical Oncology, Department of Oncology, Western University, London, ON, Canada.
Ann Hepatobiliary Pancreat Surg. 2024 May 31;28(2):229-237. doi: 10.14701/ahbps.23-107. Epub 2024 Feb 1.
BACKGROUNDS/AIMS: While patients with borderline resectable pancreatic cancer (BRPC) are a target population for neoadjuvant chemotherapy (NAC), formal guidelines for neoadjuvant therapy are lacking. We assessed the perioperative and oncological outcomes in patients with BRPC undergoing NAC with FOLFIRINOX for patients undergoing upfront surgery (US).
The AHPBA criteria for borderline resectability and/or a CA19-9 level > 100 μ/mL defined borderline resectable tumors retrieved from a prospectively populated institutional registry from 2007 to 2020. The primary outcome was overall survival (OS) at 1 and 3 years. A Cox Proportional Hazard model based on intention to treat was used. A receiver-operator characteristics (ROC) curve was constructed to assess the discriminatory capability of the use of CA19-9 > 100 μ/mL to predict resectability and mortality.
Forty BRPC patients underwent NAC, while 46 underwent US. The median OS with NAC was 19.8 months (interquartile range [IQR], 10.3-44.24) vs. 10.6 months (IQR, 6.37-17.6) with US. At 1 year, 70% of the NAC group and 41.3% of the US group survived ( = 0.008). At 3 years, 42.5 % of the NAC group and 10.9% of the US group survived ( = 0.001). NAC significantly reduced the hazard of death (adjusted hazard ratio, 0.20; 95% confidence interval, 0.07-0.54; = 0.001). CA19-9 > 100 μ/mL showed poor discrimination in predicting mortality, but was a moderate predictor of resectability.
We found a survival benefit of NAC with FOLFIRINOX for BRPC. Greater pre-treatment of CA19-9 and multivessel involvement on initial imaging were associated with progression of the disease following NAC.
背景/目的：虽然局部可切除胰腺癌（BRPC）患者是新辅助化疗（NAC）的目标人群，但缺乏新辅助治疗的正式指南。我们评估了接受FOLFIRINOX方案新辅助化疗的BRPC患者与接受 upfront 手术（US）患者的围手术期和肿瘤学结局。
采用美国胰腺疾病协会（AHPBA）制定的局部可切除标准和/或 CA19-9 水平>100 μ/mL 来定义从 2007 年至 2020 年前瞻性建立的机构登记处中检索出的局部可切除肿瘤。主要结局是 1 年和 3 年的总生存期（OS）。使用基于意向性治疗的Cox 比例风险模型。构建受试者工作特征（ROC）曲线以评估使用 CA19-9>100 μ/mL 预测可切除性和死亡率的判别能力。
40例BRPC患者接受了新辅助化疗，46例接受了 upfront 手术。新辅助化疗组的中位总生存期为19.8个月（四分位间距[IQR]，10.3 - 44.24），而 upfront 手术组为10.6个月（IQR，6.37 - 17.6）。1 年时，新辅助化疗组70%的患者存活，upfront 手术组为41.3%（P = 0.008）。3 年时，新辅助化疗组42.5%的患者存活，upfront 手术组为10.9%（P = 0.001）。新辅助化疗显著降低了死亡风险（调整后风险比，0.20；95%置信区间，0.07 - 0.54；P = 0.001）。CA19-9>100 μ/mL 在预测死亡率方面判别能力较差，但在预测可切除性方面为中等预测指标。
我们发现FOLFIRINOX方案新辅助化疗对BRPC患者有生存获益。治疗前较高的CA19-9水平和初始影像学检查发现多血管受累与新辅助化疗后疾病进展相关。
