Role of surgical resection in the era of FOLFIRINOX for advanced pancreatic cancer
Role of surgical resection in the era of FOLFIRINOX for advanced pancreatic cancer
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DOI：
10.1002/jhbp.648
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发表时间：
2019-07-24
影响因子：
3
通讯作者：
Jang, Jin-Young
中科院分区：
文献类型：
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作者：
Byun, Yoonhyeong;Han, Youngmin;Jang, Jin-Young
背景FOLFIRINOX方案的引入极大地改变了晚期胰腺癌的治疗。然而，对临床疗效和影响预后的因素的详细研究不足。本研究旨在评价FOLFIRINOX联合手术切除治疗晚期胰腺癌的疗效。方法回顾性分析2011年1月至2017年12月间首次接受FOLFIRINOX治疗的337例晚期胰腺癌患者。根据国家综合癌症网络指南对患者进行评价，根据实体瘤疗效评价标准重新评价FOLFIRINOX 4 - 6个周期后的疗效，并在多学科会议上决定进一步治疗。结果交界性胰腺癌67例（19.9%），局部晚期胰腺癌135例（40.1%），转移性胰腺癌135例（40.1%）。在各个临床分期中，手术组的中位生存期均显著长于非手术组，即使是转移性胰腺癌（32 vs. 14，P = 0.012）。在多变量分析中，诊断时的转移状态、FOLFIRINOX后疾病进展、手术切除和FOLFIRINOX后CA 19 -9下降是重要的预后因素。结论手术治疗对FOLFIRINOX治疗晚期胰腺癌的生存率有很大影响。最佳手术指征和手术方案有待进一步研究。
Background The introduction of FOLFIRINOX regimen greatly changed the treatment for advanced pancreatic cancers. However, detailed studies on the clinical effects and factors affecting the prognosis are insufficient. We performed this study to evaluate the effects of FOLFIRINOX and the surgical resection in advanced pancreatic cancer. Methods Three hundred and thirty-seven patients with advanced pancreatic cancer who initially received FOLFIRINOX, from January 2011 to December 2017, were retrospectively reviewed. Patients were evaluated according to the National Comprehensive Cancer Network guideline, responses after four to six cycles of FOLFIRINOX were re-evaluated according to the response evaluation criteria in solid tumors, and further treatment was decided in the multidisciplinary meeting. Results Sixty-seven (19.9%) patients had borderline resectable pancreatic cancer, 135 (40.1%) locally advanced pancreatic cancer, and 135 (40.1%) metastatic pancreatic cancer. The median survival period was significantly longer in the surgical group than in the nonsurgical group in each clinical stage, even in metastatic pancreatic cancer (32 vs. 14, P = 0.012). In multivariate analysis, metastatic status at diagnosis, progressive disease after FOLFIRINOX, surgical resection, and declined CA19-9 after FOLFIRINOX were significant prognostic factors. Conclusions Surgical treatment greatly affects survival outcomes in advanced pancreatic cancer treated with FOLFIRINOX. Further studies on the optimal indication of operation and the protocol are needed.