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Prognostic Factors for Patients with Borderline Resectable or Locally Advanced Pancreatic Cancer Receiving Neoadjuvant FOLFIRINOX

Gut and Liver 2021년 15권 2호 p.315 ~ 323
최영훈, 이상협, 유민수, 신방섭, 백우현, 류지곤, 김용태, 권우일, 장진영, 김선회,
소속 상세정보
최영훈 ( Choi Young-Hoon ) - Catholic University College of Medicine Department of Internal Medicine
이상협 ( Lee Sang-Hyub ) - Seoul National University Hospital Department of Internal Medicine
유민수 ( You Min-Su ) - Seoul National University Hospital Department of Internal Medicine
신방섭 ( Shin Bang-Sup ) - Seoul National University Hospital Department of Internal Medicine
백우현 ( Paik Woo-Hyun ) - Seoul National University Hospital Department of Internal Medicine
류지곤 ( Ryu Ji-Kon ) - Seoul National University Hospital Department of Internal Medicine
김용태 ( Kim Yong-Tae ) - Seoul National University Hospital Department of Internal Medicine
권우일 ( Kwon Woo-Il ) - Seoul National University College of Medicine Seoul National University Hospital Department of Surgery
장진영 ( Jang Jin-Young ) - Seoul National University College of Medicine Seoul National University Hospital Department of Surgery
김선회 ( Kim Sun-Whe ) - Seoul National University College of Medicine Seoul National University Hospital Department of Surgery

Abstract


Background/Aims: There has been growing evidence on the utility of neoadjuvant FOLFIRINOX in borderline resectable (BR) or locally advanced (LA) pancreatic cancer. However, factors predicting survival in these patients remain to be identified, and we aimed to identify these prognostic factors.

Methods: Between January 2013 and April 2017, patients with BR or LA pancreatic cancer who received FOLFIRINOX as their initial treatment were identified. Demographic data and clinical outcomes, including the chemotherapy response, conversion to resection, and survival, were reviewed.

Results: A total of 117 patients with BR (n=39) or LA (n=78) pancreatic cancer were included. Of these patients, 29 (24.8%) underwent curative surgery, and R0 resection was achieved in 21 patients (72.4%). The median progression-free survival and overall survival time of all patients were 11.6 and 19.0 months, respectively. In resected patients, the median relapse-free survival and overall survival times were 14.8 and 28.6 months, respectively. In the multivariate Cox model, the lowest level of serum carbohydrate antigen 19-9 (CA 19-9) and resection after FOLFIRINOX were independent factors for improved overall survival. In the subgroup analysis of patients with initial 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) images, the maximum standardized uptake value (SUVmax) of the pancreatic mass was also shown as an independent factor for improved overall survival.

Conclusions: In patients with BR or LA pancreatic cancer, FOLFIRINOX is a valuable neoadjuvant treatment that enables curative surgery in approximately one-quarter of patients and significantly improves overall survival. In these patients, the prognosis can be estimated using the lowest level of serum CA 19-9, operative status, and initial FDG-PET SUVmax.

키워드

Pancreatic neoplasms; Neoadjuvant therapy; FOLFIRINOX; Survival; Prognosis

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