1. Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis.
- Author
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Brada LJH, Daamen LA, Magermans LG, Walma MS, Latifi D, van Dam RM, de Hingh IH, Liem MSL, de Meijer VE, Patijn GA, Festen S, Stommel MWJ, Bosscha K, Polée MB, Nio YC, Wessels FJ, de Vries JJJ, van Lienden KP, Bruijnen RC, Busch OR, Koerkamp BG, van Eijck C, Molenaar QI, Wilmink HJW, van Santvoort HC, and Besselink MG
- Subjects
- Antineoplastic Agents therapeutic use, Female, Fluorouracil therapeutic use, Follow-Up Studies, Humans, Irinotecan therapeutic use, Leucovorin therapeutic use, Male, Middle Aged, Netherlands epidemiology, Oxaliplatin therapeutic use, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms therapy, Prospective Studies, Survival Rate trends, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Neoplasm Staging, Pancreas pathology, Pancreatectomy methods, Pancreatic Neoplasms mortality, Propensity Score
- Abstract
Objective: This study compared median OS after resection of LAPC after upfront FOLFIRINOX versus a propensity-score matched cohort of LAPC patients treated with FOLFIRINOX-only (ie, without resection)., Background: Because the introduction of FOLFIRINOX chemotherapy, increased resection rates in LAPC patients have been reported, with improved OS. Some studies have also reported promising OS with FOLFIRINOX-only treatment in LAPC. Multicenter studies assessing the survival benefit associated with resection of LAPC versus patients treated with FOLFIRINOX-only are lacking., Methods: Patients with non-progressive LAPC after 4 cycles of FOLFIRINOX treatment, both with and without resection, were included from a prospective multicenter cohort in 16 centers (April 2015-December 2019). Cox regression analysis identified predictors for OS. One-to-one propensity score matching (PSM) was used to obtain a matched cohort of patients with and without resection. These patients were compared for OS., Results: Overall, 293 patients with LAPC were included, of whom 89 underwent a resection. Resection was associated with improved OS (24 vs 15 months, P < 0.01), as compared to patients without resection. Before PSM, resection, Charlson Comorbidity Index, and Response Evaluation Criteria in Solid Tumors (RECIST) response were predictors for OS. After PSM, resection remained associated with improved OS [Hazard Ratio (HR) 0.344, 95% confidence interval (0.222-0.534), P < 0.01], with an OS of 24 versus 15 months, as compared to patients without resection. Resection of LAPC was associated with improved 3-year OS (31% vs 11%, P < 0.01)., Conclusions: Resection of LAPC after FOLFIRINOX was associated with increased OS and 3-year survival, as compared to propensity-score matched patients treated with FOLFIRINOX-only., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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