Addeo Pietro, Muzzolini Milena, Laurent Christophe, Heyd Bruno, Sauvanet Alain, Garnier Jonathan, Alfano Marie Sophie, Gaujoux Sebastien, De Ponthaud Charles, Marchese Ugo, Da Silva Doris, Buc Emmanuel, Souche Regis, Fabre Jean Michel, Colombo Pierre-Emanuel, Ferre Lorenzo, Foguenne Maxime, Hubert Catherine, El Amrani Mehdi, Truant Stephanie, Schwartz Lilian, Regenet Nicolas, Dupre Aurelien, Brustia Raffaele, Cherif Rim, Navez Julie, Darnis Benjamin, Facy Olivier, Grellet Robin, Piessen Guillaume, Veziant Julie, Rhaiem Rami, Kianmanesh Reza, Fernandez-De-Sevilla Elena, Gelli Maximiliano, Taibi Abdelkader, Georges Pauline, Mabrut Jean Yves, Lesurtel Mickael, Doussot Alexandre, Bachellier Philippe
Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives et Hépatiques, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
Department of HBP Surgery, AP-HP, Hôpital Beaujon, University of Paris, Clichy, France.
Ann Surg Oncol. 2025 Apr;32(4):2809-2818. doi: 10.1245/s10434-024-16735-2. Epub 2025 Jan 8.
The use of multiagent FOLFIRINOX chemotherapy for pancreatic adenocarcinoma in a neoadjuvant setting has been associated with an increased rate of complete pathological response (CPR) after surgery. This study investigated the long-term outcomes of patients with CPR in a multicenter setting to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS).
This retrospective cohort study examined biopsy-proven pancreatic adenocarcinomas with CPR after neoadjuvant chemotherapy or chemoradiotherapy and surgery, between January 2006 and December 2023 across 22 French and 2 Belgian centers. Cox analyses were used to identify prognostic factors of OS and RFS.
There were 101 patients with CPR after chemotherapy (n = 58, 57.4%) and chemoradiotherapy (n = 43, 42.6%) followed by surgery. Neoadjuvant FOLFIRINOX was used in 90% of patients. The median OS after surgery was 177 months (95% confidence interval (CI) 58.9-177 months) with 1-, 3-, 5-, and 10-year OS rates of 93%, 75%, 63%, and 51%, respectively. The median RFS was 67.8 months (95% CI:34.4-NR) with 1-, 3-, 5-, and 10-year RFS rates of 83%, 58%, 54%, and 49%, respectively. The multivariate Cox analysis of OS and RFS showed that preoperative radiotherapy was an independent negative prognostic factor for OS (hazard ratio (HR) 2.51; 95% CI 1.00-6.30; p = 0.03) and RFS (HR 2.62; 95% CI 1.27-5.41; p = 0.009).
Complete pathologic response after neoadjuvant treatment is associated with remarkable long-term survival that is usually not seen after the resection of pancreatic adenocarcinomas. One-third of the patients still experienced disease recurrence, which was more common in those receiving preoperative chemoradiotherapy.
在新辅助治疗中使用多药联合的FOLFIRINOX化疗方案治疗胰腺腺癌，与术后完全病理缓解（CPR）率的提高相关。本研究在多中心环境下调查了CPR患者的长期预后，以确定总生存期（OS）和无复发生存期（RFS）的预后因素。
这项回顾性队列研究检查了2006年1月至2023年12月期间，在22个法国和2个比利时中心接受新辅助化疗或放化疗及手术后经活检证实为胰腺腺癌且达到CPR的患者。采用Cox分析来确定OS和RFS的预后因素。
化疗后（n = 58，57.4%）和放化疗后（n = 43，42.6%）接受手术的患者中有101例达到CPR。90%的患者使用了新辅助FOLFIRINOX。术后中位OS为177个月（95%置信区间（CI）58.9 - 177个月），1年、3年、5年和10年OS率分别为93%、75%、63%和51%。中位RFS为67.8个月（95% CI：34.4 - NR），1年、3年、5年和10年RFS率分别为83%、5%、54%和49%。OS和RFS的多变量Cox分析显示，术前放疗是OS（风险比（HR）2.51；95% CI 1.00 - 6.30；p = 0.03）和RFS（HR 2.62；95% CI 1.27 - 5.41；p = 0.009）的独立负性预后因素。
新辅助治疗后的完全病理缓解与显著的长期生存相关，这在胰腺腺癌切除术后通常是看不到的。三分之一的患者仍经历疾病复发，这在接受术前放化疗的患者中更为常见。
