Survival Outcomes Associated With Clinical and Pathological Response Following Neoadjuvant FOLFIRINOX or Gemcitabine/Nab-Paclitaxel Chemotherapy in Resected Pancreatic Cancer.
Survival Outcomes Associated With Clinical and Pathological Response Following Neoadjuvant FOLFIRINOX or Gemcitabine/Nab-Paclitaxel Chemotherapy in Resected Pancreatic Cancer.
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DOI：
10.1097/sla.0000000000003468
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发表时间：
2019-09
影响因子：
9
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中科院分区：
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目的：比较新辅助化疗(NAC)联合FOLFIRINOX(氟立诺酮)或吉西他滨/NAB-紫杉醇(GNP)联合根治性胰腺切除术对胰腺癌(PDAC)患者临床和病理疗效的影响。较新的多药NAC方案已经改善了PDAC的临床和病理反应；然而，这些反应对生存结果的影响尚不清楚。对7个学术医学中心收治的PDAC患者的临床病理和生存资料进行分析。主要结果是总生存期(OS)、局部无复发生存期(L-RFs)和无转移生存期(MFS)与生化指标(CA19-9使≥下降50%比50%)和病理反应(完全缓解、部分缓解、部分缓解或有限缓解)相关。在纳入的274例患者中，46.4%为交界性切除，25.5%为局部晚期，83.2%为胰头颈部肿瘤。静脉切除占34.7%，30d死亡率为2.2%。R0和PCR率分别为82.5%和6%。中位、3年和5年OS分别为32个月、46.3%和30.3%。在有明显生化反应(CA19-9降低≥50%vs 50%；OS：42.3vs 24.3个月，P<；0.001；L-RFS27.3vs14.1月，P=0.042；MFS-29.3vs13个月，P=0.047)和病理反应[PCRvsPPRvsPLR：OS未达(NR)vs40.3vs26.1个月，P<；0.001；L-RFS-NR24.5月vs21.4月，P=0.044；MFS-NR23.7vs20.2月，P=0.017]。接受氟尿嘧啶和硝普钠治疗的患者在L-RFS、MFS和OS方面没有差异。这项大型的多中心研究表明，与NAC、Flx或GNP相关的生化、病理和临床反应的改善导致了PDAC中OS、L-RFs和MFS的改善。NAC+氟尿嘧啶或GNP有相似的生存结局。
To compare the survival outcomes associated with clinical and pathological response in pancreatic ductal adenocarcinoma (PDAC) patients receiving neoadjuvant chemotherapy (NAC) with FOLFIRINOX (FLX) or gemcitabine/nab-paclitaxel (GNP) followed by curative-intent pancreatectomy. Newer multiagent NAC regimens have resulted in improved clinical and pathological responses in PDAC; however, the effects of these responses on survival outcomes remain unknown. Clinicopathological and survival data of PDAC patients treated at 7 academic medical centers were analyzed. Primary outcomes were overall survival (OS), local recurrence-free survival (L-RFS), and metastasis-free survival (MFS) associated with biochemical (CA 19–9 decrease ≥50% vs <50%) and pathological response (complete, pCR; partial, pPR or limited, pLR) following NAC. Of 274 included patients, 46.4% were borderline resectable, 25.5% locally advanced, and 83.2% had pancreatic head/neck tumors. Vein resection was performed in 34.7% and 30-day mortality was 2.2%. R0 and pCR rates were 82.5% and 6%, respectively. Median, 3-year, and 5-year OS were 32 months, 46.3%, and 30.3%, respectively. OS, L-RFS, and MFS were superior in patients with marked biochemical response (CA 19–9 decrease ≥50% vs <50%; OS: 42.3 vs 24.3 months, P < 0.001; L-RFS-27.3 vs 14.1 months, P = 0.042; MFS-29.3 vs 13 months, P = 0.047) and pathological response [pCR vs pPR vs pLR: OS- not reached (NR) vs 40.3 vs 26.1 months, P < 0.001; L-RFS-NR vs 24.5 vs 21.4 months, P = 0.044; MFS-NR vs 23.7 vs 20.2 months, P = 0.017]. There was no difference in L-RFS, MFS, or OS between patients who received FLX or GNP. This large, multicenter study shows that improved biochemical, pathological, and clinical responses associated with NAC FLX or GNP result in improved OS, L-RFS, and MFS in PDAC. NAC with FLX or GNP has similar survival outcomes.