Barenboim Alex, Mercer Diego, Sahnan Kapil, Gaffan Alex, Goren Or, Halperin Sharon, Brazowski Eli, Pelles Avraham Sharon, Klausner Joseph M, Lubezky Nir
Department of Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel-Aviv 6997801, Israel.
Department of Radiology, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel-Aviv 6997801, Israel.
J Clin Med. 2024 Sep 2;13(17):5206. doi: 10.3390/jcm13175206.
: The National Comprehensive Cancer Network (NCCN)-recommended treatment for patients with borderline-resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) involves a combination of neoadjuvant FOLFIRINOX chemotherapy and the curative surgical resection of the tumor. This study seeks to identify the clinical, radiological, laboratory, and pathologic predictors that can anticipate the oncological outcomes of patients. : In this study, we conducted a retrospective analysis of patients who had undergone curative surgical resection for BRPC, LAPC, or resectable disease with high-risk features after receiving neoadjuvant FOLFIRINOX at two institutions. We evaluated by means of multivariate analysis whether clinical and laboratory response, tumor markers, radiological response, and pathologic tumor response grade correlated with overall survival (OS) and disease-free survival (DFS). : The study enrolled a total of 70 patients with BRPC, LAPC, and resectable disease with high-risk features who underwent resection after neoadjuvant FOLFIRINOX. Age above 65 years and fewer than nine cycles of chemotherapy (OR 4.2; 95% CI 1.4-12.0; -value 0.007); locally advanced tumors after neoadjuvant treatment (NAT) (OR 7.0; 95% CI 1.9-25.7; -value 0.003); and lymph node disease and histological tumor regression grade 2 and 3 (OR 4.3; 95% CI 0.9-19.2; -value 0.05) were risk factors linked to adverse OS and DFS. The median OS and DFS were 33 (22-43.9) months and 16.5 (11.3-21.6) months, respectively. : Classification as a LA tumor after NAT was the only preoperative radiological factor that predicted adverse survival in patients undergoing curative surgery after NAT. Other clinical, biochemical, and radiological measures of response were not found to predict OS. Patient age, the cumulative administration of more than eight cycles of chemotherapy, and a significant pathological response were associated with better OS. The results of this study are important for treatment decision-making and prognostication in patients with BRPC and LAPC.
美国国立综合癌症网络（NCCN）推荐的可切除边缘性胰腺癌（BRPC）和局部晚期胰腺癌（LAPC）患者的治疗方法包括新辅助FOLFIRINOX化疗与肿瘤根治性手术切除相结合。本研究旨在确定能够预测患者肿瘤学结局的临床、影像学、实验室和病理预测指标。：在本研究中，我们对两家机构中接受新辅助FOLFIRINOX治疗后因BRPC、LAPC或具有高危特征的可切除疾病而接受根治性手术切除的患者进行了回顾性分析。我们通过多变量分析评估临床和实验室反应、肿瘤标志物、影像学反应和病理肿瘤反应分级是否与总生存期（OS）和无病生存期（DFS）相关。：该研究共纳入70例BRPC、LAPC和具有高危特征的可切除疾病患者，这些患者在接受新辅助FOLFIRINOX治疗后接受了手术切除。65岁以上且化疗周期少于9个周期（比值比4.2；95%置信区间1.4 - 12.0；P值0.007）；新辅助治疗（NAT）后为局部晚期肿瘤（比值比7.0；95%置信区间1.9 - 25.7；P值0.003）；以及淋巴结疾病和组织学肿瘤退缩分级为2级和3级（比值比4.3；95%置信区间0.9 - 19.2；P值0.05）是与不良OS和DFS相关的危险因素。中位OS和DFS分别为33（22 - 43.9）个月和16.5（11.3 - 21.6）个月。：NAT后被分类为LA肿瘤是预测NAT后接受根治性手术患者不良生存的唯一术前影像学因素。未发现其他临床、生化和影像学反应指标可预测OS。患者年龄、化疗累积超过8个周期以及显著的病理反应与更好的OS相关。本研究结果对于BRPC和LAPC患者的治疗决策和预后评估具有重要意义。
