Tumor Size Reduction and Serum Carbohydrate Antigen 19-9 Kinetics After Neoadjuvant FOLFIRINOX in Patients With Pancreatic Ductal Adenocarcinoma.

Autor: Servin-Rojas M; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: http://www.twitter.com/servinrojasmd., Fong ZV; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: http://www.twitter.com/zhivenfongmd., Fernandez-Del Castillo C; Department of Surgery, Massachusetts General Hospital, Boston, MA., Ferrone CR; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: http://www.twitter.com/cferronemd., Lee H; Department of Biostatistics, Massachusetts General Hospital, Boston, MA., Lopez-Verdugo F; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: http://www.twitter.com/fidel_lv., Qiao G; Department of Surgery, Massachusetts General Hospital, Boston, MA., Rocha-Castellanos DM; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: http://www.twitter.com/dariorochamd., Lillemoe KD; Department of Surgery, Massachusetts General Hospital, Boston, MA., Qadan M; Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: mqadan@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Feb; Vol. 175 (2), pp. 471-476. Date of Electronic Publication: 2023 Nov 10.
DOI: 10.1016/j.surg.2023.09.041
Abstrakt: Background: Changes in tumor size and serum carbohydrate antigen 19-9 are commonly reported markers used to assess response to neoadjuvant therapy in pancreatic ductal adenocarcinoma. We evaluated the impact of the percentual tumor size reduction and carbohydrate antigen 19-9 kinetics on resectability and response to neoadjuvant FOLFIRINOX.
Methods: This was an institutional analysis of patients with non-metastatic (upfront resectable, borderline resectable, and locally advanced) pancreatic ductal adenocarcinoma who underwent neoadjuvant FOLFIRINOX. Resectability, pathologic response, disease recurrence, and overall survival were evaluated.
Results: Among 193 patients who completed FOLFIRINOX, 60% underwent resection, and 91% were R0. Pathologically, complete, and near-complete responses were achieved in 4% and 40% of patients, respectively. Tumor size reduction (odds ratio 1.02 per 1%, P = .024) and normalization of carbohydrate antigen 19-9 (odds ratio 2.61, P = .035) were associated with increased odds of resectability. Concerning pathologic response, tumor size reduction (odds ratio 1.03 per 1%, P = .018) was associated with increased odds of a complete and near-complete response. Lastly, in resected patients, a postoperative increase in carbohydrate antigen 19-9 after prior normalization after neoadjuvant therapy were at an increased risk of recurrence (hazard ratio 9.58, P < .001) and worse survival (hazard ratio 10.4, P < .001) compared to patients who maintained normalization.
Conclusion: In patients with non-metastatic pancreatic ductal adenocarcinoma who underwent neoadjuvant therapy, tumor size reduction was a significant predictor of resectability and pathologic response, including complete and near complete responses, whereas serum carbohydrate antigen 19-9 normalization predicted resectability, disease recurrence, and survival. Patients with a postoperative carbohydrate antigen 19-9 rise after prior normalization after administration of neoadjuvant therapy were at an increased risk of recurrence and worse overall survival.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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