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Multicenter Study
. 2021 Nov 1;274(5):729-735.
doi: 10.1097/SLA.0000000000005120.

Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis

Lilly J H Brada  1   2 , Lois A Daamen  2 , Lisa G Magermans  2 , Marieke S Walma  1   2 , Diba Latifi  3 , Ronald M van Dam  4   5   6 , Ignace H de Hingh  6   7 , Mike S L Liem  8 , Vincent E de Meijer  9 , Gijs A Patijn  10 , Sebastiaan Festen  11 , Martijn W J Stommel  12 , Koop Bosscha  13 , Marco B Polée  14 , Yung C Nio  15 , Frank J Wessels  16 , Jan J J de Vries  17 , Krijn P van Lienden  16 , Rutger C Bruijnen  16 , Olivier R Busch  1 , Bas Groot Koerkamp  3 , Casper van Eijck  3 , Quintus I Molenaar  2 , Hanneke J W Wilmink  18 , Hjalmar C van Santvoort  2 , Marc G Besselink  1 ; Dutch Pancreatic Cancer Group
Affiliations
Multicenter Study

Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis

Lilly J H Brada et al. Ann Surg. .

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.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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