Survival Benefit of Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma Who Underwent Surgery Following Neoadjuvant FOLFIRINOX
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Purpose The benefit of adjuvant chemotherapy following curative-intent surgery in pancreatic ductal adenocarcinoma (PDAC) patients who had received neoadjuvant FOLFIRINOX is unclear. This study aimed to assess the survival benefit of adjuvant chemotherapy in this patient population. Materials and Methods This retrospective study included 218 patients with localized non-metastatic PDAC who received neoadjuvant FOLFIRINOX and underwent curative-intent surgery (R0 or R1) between January 2017 and December 2020. The association of adjuvant chemotherapy with disease-free survival (DFS) and overall survival (OS) was evaluated in overall patients and in the propensity score matched (PSM) cohort. Subgroup analysis was conducted according to the pathology-proven lymph node status. Results Adjuvant chemotherapy was administered to 149 patients (68.3%). In the overall cohort, the adjuvant chemotherapy group had significantly improved DFS and OS compared to the observation group (DFS: median, 13.8 months [95% confidence interval (CI), 11.0 to 19.1] vs. 8.2 months [95% CI, 6.5 to 12.0]; p < 0.001; and OS: median, 38.0 months [95% CI, 32.2 to not assessable] vs. 25.7 months [95% CI, 18.3 to not assessable]; p=0.005). In the PSM cohort of 57 matched pairs of patients, DFS and OS were better in the adjuvant chemotherapy group than in the observation group (p < 0.001 and p=0.038, respectively). In the multivariate analysis, adjuvant chemotherapy was a significant favorable prognostic factor (vs. observation; DFS: hazard ratio [HR], 0.51 [95% CI, 0.36 to 0.71; p < 0.001]; OS: HR, 0.45 [95% CI, 0.29 to 0.71; p < 0.001]). Conclusion Among PDAC patients who underwent surgery following neoadjuvant FOLFIRINOX, adjuvant chemotherapy may be associated with improved survival. Randomized studies should be conducted to validate this finding.
Abstract
Purpose The benefit of adjuvant chemotherapy following curative-intent surgery in pancreatic ductal adenocarcinoma (PDAC) patients who had received neoadjuvant FOLFIRINOX is unclear. This study aimed to assess the survival benefit of adjuvant chemotherapy in this patient population. Materials and Methods This retrospective study included 218 patients with localized non-metastatic PDAC who received neoadjuvant FOLFIRINOX and underwent curative-intent surgery (R0 or R1) between January 2017 and December 2020. The association of adjuvant chemotherapy with disease-free survival (DFS) and overall survival (OS) was evaluated in overall patients and in the propensity score matched (PSM) cohort. Subgroup analysis was conducted according to the pathology-proven lymph node status. Results Adjuvant chemotherapy was administered to 149 patients (68.3%). In the overall cohort, the adjuvant chemotherapy group had significantly improved DFS and OS compared to the observation group (DFS: median, 13.8 months [95% confidence interval (CI), 11.0 to 19.1] vs. 8.2 months [95% CI, 6.5 to 12.0]; p < 0.001; and OS: median, 38.0 months [95% CI, 32.2 to not assessable] vs. 25.7 months [95% CI, 18.3 to not assessable]; p=0.005). In the PSM cohort of 57 matched pairs of patients, DFS and OS were better in the adjuvant chemotherapy group than in the observation group (p < 0.001 and p=0.038, respectively). In the multivariate analysis, adjuvant chemotherapy was a significant favorable prognostic factor (vs. observation; DFS: hazard ratio [HR], 0.51 [95% CI, 0.36 to 0.71; p < 0.001]; OS: HR, 0.45 [95% CI, 0.29 to 0.71; p < 0.001]). Conclusion Among PDAC patients who underwent surgery following neoadjuvant FOLFIRINOX, adjuvant chemotherapy may be associated with improved survival. Randomized studies should be conducted to validate this finding.
참고문헌 (32)
- Groot VP, "Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma", Ann Surg, 267, pp.936~945 (2018)
- Maeda S, "Adjuvant and neoadjuvant therapy for pancreatic cancer", J Pancreatol, 2, pp.100~106 (2019)
- McGuigan A, "Pancreatic cancer : a review of clinical diagnosis, epidemiology, treatment and outcomes", World J Gastroenterol, 24, pp.4846~4861 (2018)
- Ducreux M, "Cancer of the pancreas : ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up", Ann Oncol, 26(Suppl 5), pp.v56~68 (2015)
- Conroy T, "FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer", N Engl J Med, 379, pp.2395~2406 (2018)
- Neoptolemos JP, "Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer(ESPAC-4) : a multicentre, open-label, randomised, phase 3 trial", Lancet, 389, pp.1011~1024 (2017)
- Oettle H, "Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer : the CONKO-001 randomized trial", JAMA, 310, pp.1473~1481 (2013)
- Nagakawa Y, "Clinical impact of neoadjuvant chemotherapy and chemoradiotherapy in borderline resectable pancreatic cancer : analysis of 884 patients at facilities specializing in pancreatic surgery", Ann Surg Oncol, 26, pp.1629~1636 (2019)
- Oba A, "Neoadjuvant treatment in pancreatic cancer", Front Oncol, 10, pp.245~ (2020)
- Unno M, "Long-term outcome following neoadjuvant therapy for resectable and borderline resectable pancreatic cancer compared to upfront surgery : a meta-analysis of comparative studies by intention-to-treat analysis", Surg Today, 49, pp.295~299 (2019)
- Versteijne E, "Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer", Br J Surg, 105, pp.946~958 (2018)
- Yoo C, "Clinical outcomes of conversion surgery after neoadjuvant chemotherapy in patients with borderline resectable and locally advanced unresectable pancreatic cancer : a single-center, retrospective analysis", Cancers(Basel), 11, pp.278~ (2019)
- Yoo C, "Neoadjuvant modified FOLFIRINOX followed by postoperative gemcitabine in borderline resectable pancreatic adenocarcinoma : a Phase 2 study for clinical and biomarker analysis", Br J Cancer, 123, pp.362~368 (2020)
- Suker M, "FOLFIRINOX for locally advanced pancreatic cancer : a systematic review and patient-level meta-analysis", Lancet Oncol, 17, pp.801~810 (2016)
- Conroy T, "FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer", N Engl J Med, 364, pp.1817~1825 (2011)
- Janssen QP, "Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer : a systematic review and patient-level meta-analysis", J Natl Cancer Inst, 111, pp.782~794 (2019)
- Kamarajah SK, "Adjuvant chemotherapy associated with survival benefit following neoadjuvant chemotherapy and pancreatectomy for pancreatic ductal adenocarcinoma : a population-based cohort study", Ann Surg Oncol, 28, pp.6790~6802 (2021)
- van Roessel S, "Evaluation of adjuvant chemotherapy in patients with resected pancreatic cancer after neoadjuvant FOLFIRINOX treatment", JAMA Oncol, 6, pp.1733~1740 (2020)
- Tempero MA, "Pancreatic adenocarcinoma, version 2. 2017, NCCN Clinical Practice Guidelines in Oncology", J Natl Compr Canc Netw, 15, pp.1028~1061 (2017)
- Allen PJ, "Multi-institutional validation study of the American Joint Commission on Cancer(8th Edition)changes for T and N staging in patients with pancreatic adenocarcinoma", Ann Surg, 265, pp.185~191 (2017)
- "Protocol for the examination of specimens from patients with carcinoma of the exocrine pancreas" (2012)[URL]
- Roland CL, "The addition of postoperative chemotherapy is associated with improved survival in patients with pancreatic cancer treated with preoperative therapy", Ann Surg Oncol, 22(Suppl 3), pp.S1221~8 (2015)
- Olecki EJ, "Adjuvant chemotherapy after neoadjuvant chemotherapy for pancreatic cancer is associated with improved survival for patients with low-risk pathology", Ann Surg Oncol, 28, pp.3111~3122 (2021)
- Barnes CA, "Is adjuvant therapy necessary for all patients with localized pancreatic cancer who have received neoadjuvant therapy?", J Gastrointest Surg, 21, pp.1793~1803 (2017)
- Swords DS, "Lymph node ratio in pancreatic adenocarcinoma after preoperative chemotherapy vs. preoperative che-moradiation and its utility in decisions about postoperative chemotherapy", J Gastrointest Surg, 23, pp.1401~1413 (2019)
- Carrato A, "Sequential nab-paclitaxel", gemcitabine followed by modified FOLFOX for first-line metastatic pancreatic cancer : The SEQUENCE trial, 2022, pp.40, 4022~
- Rinaldi Y, "Gemcitabine plus nab-paclitaxel until progression or alternating with FOLFIRI. 3, as first-line treatment for patients with metastatic pancreatic adenocarcinoma : the Federation Francophone de Cancerologie Digestive-PRODIGE 37 randomised phase II study(FIRGEMAX)", Eur J Cancer, 136, pp.25~34 (2020)
- Truty MJ, "Factors predicting response, perioperative outcomes, and survival following total neoadjuvant therapy for borderline", locally advanced pancreatic cancer, 2021, pp.273, 341~349
- Garnier J, "Pancreatectomy with vascular resection after neoadjuvant FOLFIRINOX : who survives more than a year after surgery?", Ann Surg Oncol, 28, pp.4625~4634 (2021)
- Michelakos T, "Predictors of resectability and survival in patients eith borderline and locally advanced pancreatic cancer who underwent neoadjuvant treatment with FOLFIRINOX", Ann Surg, 269, pp.733~740 (2019)
- Yoo C, "FOLFIRINOX in borderline resectable and locally advanced unresectable pancreatic adenocarcinoma", Ther Adv Med Oncol, 12, pp.1758835920953294~ (2020)
- Pietrasz D, "Pathologic major response after FOLFIRINOX is prognostic for patients secondary resected for borderline or locally advanced pancreatic adenocarcinoma : an AGEO-FRENCH, prospective, multicentric cohort", Ann Surg Oncol, 22(Suppl 3), pp.S1196~205 (2015)