Postoperative Chemotherapy is Associated with Improved Survival in Patients with Node-Positive Pancreatic Ductal Adenocarcinoma After Neoadjuvant Therapy.

Autor: Ivey GD; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Shoucair S; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Delitto DJ; Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA., Habib JR; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Kinny-Köster B; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA., Shubert CR; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Lafaro KJ; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Cameron JL; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Burns WR; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Burkhart RA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Thompson EL; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Narang A; Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Zheng L; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Wolfgang CL; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA., He J; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jhe11@jhmi.edu.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2022 Nov; Vol. 46 (11), pp. 2751-2759. Date of Electronic Publication: 2022 Jul 21.
DOI: 10.1007/s00268-022-06667-x
Abstrakt: Background: Postoperative chemotherapy following pancreatic cancer resection is the standard of care. The utility of postoperative chemotherapy for patients who receive neoadjuvant therapy (NAT) is unclear.
Methods: Patients who underwent pancreatectomy after NAT with FOLFIRINOX or gemcitabine-based chemotherapy for non-metastatic pancreatic adenocarcinoma (2015-2019) were identified. Patients who received less than 2 months of neoadjuvant chemotherapy or died within 90 days from surgery were excluded.
Results: A total of 427 patients (resectable, 22.2%; borderline resectable, 37.9%; locally advanced, 39.8%) were identified with the majority (69.3%) receiving neoadjuvant FOLFIRINOX. Median duration of NAT was 4.1 months. Following resection, postoperative chemotherapy was associated with an improved median overall survival (OS) (28.7 vs. 20.4 months, P = 0.006). Risk-adjusted multivariable modeling showed negative nodal status (N0), favorable pathologic response (College of American Pathologists score 0 & 1), and receipt of postoperative chemotherapy to be independent predictors of improved OS. Regimen, duration, and number of cycles of NAT were not significant predictors. Thirty-four percent (60/176) of node-positive and 50.1% (126/251) of node-negative patients did not receive postoperative chemotherapy due to poor functional status, postoperative complications, and patient preference. Among patients with node-positive disease, postoperative chemotherapy was associated with improved median OS (27.2 vs. 10.5 months, P < 0.001). Among node-negative patients, postoperative chemotherapy was not associated with a survival benefit (median OS, 30.9 vs. 36.9 months; P = 0.406).
Conclusion: Although there is no standard NAT regimen for patients with pancreatic cancer, postoperative chemotherapy following NAT and resection appears to be associated with improved OS for patients with node-positive disease.
(© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)
Databáze: MEDLINE
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