Radiological and Surgical Implications of Neoadjuvant Treatment With FOLFIRINOX for Locally Advanced and Borderline Resectable Pancreatic Cancer
Radiological and Surgical Implications of Neoadjuvant Treatment With FOLFIRINOX for Locally Advanced and Borderline Resectable Pancreatic Cancer
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DOI：
10.1097/sla.0000000000000867
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发表时间：
2015-01-01
影响因子：
9
通讯作者：
Fernandez-del Castillo, Carlos
中科院分区：
文献类型：
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作者：
Ferrone, Cristina R.;Marchegiani, Giovanni;Fernandez-del Castillo, Carlos
目的：基于雅阁试验，FOLFIRINOX治疗转移性胰腺癌（PDAC）有效，是局部晚期PDAC（LA）的合理选择。本研究的目的是评估影像学在确定PDAC可切除性方面的准确性，并确定新辅助FOLFIRINOX治疗后胰腺切除术的手术和临床病理结果。患者和方法：回顾性收集2011年4月至2014年2月期间接受新辅助FOLFIRINOX或未接受新辅助治疗的手术PDAC患者的临床病理数据。美国肝胆胰协会/外科肿瘤学会/消化道外科学会共识指南定义了LA和边界。影像学检查由一位盲法资深胰腺外科医生进行审查。结果：188例接受PDAC切除术的患者中，40例LA/边界接受FOLFIRINOX，87例未接受新辅助治疗。FOLFIRINOX导致肿瘤大小显著减小，但仍有19例患者被归类为LA，9例被归类为边缘性。尽管FOLFIRINOX术后影像学提示持续不可切除，但92%的患者接受了R 0切除。与无新辅助治疗相比，FOLFIRINOX的手术时间（393 vs 300分钟）和失血量（600 vs 400 mL）显著延长，但手术发病率显著降低（36% vs 63%），且无术后胰瘘。住院时间（6 vs 7天）、再入院率（20% vs 30%）和死亡率（1% vs 0%）相当。在最终病理学检查中，FOLFIRINOX组的淋巴结阳性（35% vs 79%）和神经周围浸润（72% vs 95%）显著降低。中位随访时间为11个月，FOLFIRINOX显著提高了总生存率。结论：新辅助FOLFIRINOX成像后不再预测不可切除性。传统的生存率的病理学预测指标得到改善，发病率降低，与患者明确切除的癌症在提出的时候。
Purpose: On the basis of the ACCORD trial, FOLFIRINOX is effective in metastatic pancreatic adenocarcinoma (PDAC), making it a rational choice for locally advanced PDAC (LA). Aims of this study are to evaluate the accuracy of imaging in determining the resectability of PDAC and to determine the surgical and clinicopathologic outcomes of pancreatic resections after neoadjuvant FOLFIRINOX therapy.Patients and Methods: Clinicopathologic data were retrospectively collected for surgical PDAC patients receiving neoadjuvant FOLFIRINOX or no neoadjuvant therapy between April 2011 and February 2014. Americas Hepato-Pancreato-Biliary Association/Society of Surgical Oncology/Society for Surgery of the Alimentary Tract consensus guidelines defined LA and borderline. Imaging was reviewed by a blinded senior pancreatic surgeon.Results: Of 188 patients undergoing resection for PDAC, 40 LA/borderline received FOLFIRINOX and 87 received no neoadjuvant therapy. FOLFIRINOX resulted in a significant decrease in tumor size, yet 19 patients were still classified as LA and 9 as borderline. Despite post-FOLFIRINOX imaging suggesting continued unresectability, 92% had an R0 resection. When compared with no neoadjuvant therapy, FOLFIRINOX resulted in significantly longer operative times (393 vs 300 minutes) and blood loss (600 vs 400 mL), but significantly lower operative morbidity (36% vs 63%) and no postoperative pancreatic fistulas. Length of stay (6 vs 7 days), readmissions (20% vs 30%), and mortality were equivalent (1% vs 0%). On final pathology, the FOLFIRINOX group had a significant decrease in lymph node positivity (35% vs 79%) and perineural invasion (72% vs 95%). Median follow-up was 11 months with a significant increase in overall survival with FOLFIRINOX.Conclusions: After neoadjuvant FOLFIRINOX imaging no longer predicts unresectability. Traditional pathologic predictors of survival are improved, and morbidity is decreased in comparison to patients with clearly resectable cancers at the time of presentation.