Survival Outcomes Associated With Clinical and Pathological Response Following Neoadjuvant FOLFIRINOX or Gemcitabine/Nab-Paclitaxel Chemotherapy in Resected Pancreatic Cancer
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- Francis I. Macedo
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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- Emily Ryon
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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- Shishir K. Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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- Rachel M. Lee
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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- David A. Kooby
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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- Ryan C. Fields
- Department of Surgery, Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St Louis, MO
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- William G. Hawkins
- Department of Surgery, Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St Louis, MO
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- Greg Williams
- Department of Surgery, Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St Louis, MO
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- Ugwuji Maduekwe
- Division of Surgical Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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- Hong J. Kim
- Division of Surgical Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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- Syed A. Ahmad
- Division of Surgical Oncology, University of Cincinnati School of Medicine, Cincinnati, OH
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- Sameer H. Patel
- Division of Surgical Oncology, University of Cincinnati School of Medicine, Cincinnati, OH
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- Daniel E. Abbott
- Division of Surgical Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine, Madison, WI
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- Patrick Schwartz
- Division of Surgical Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine, Madison, WI
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- Sharon M. Weber
- Division of Surgical Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine, Madison, WI
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- Charles R. Scoggins
- Division of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY.
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- Robert C. G. Martin
- Division of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY.
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- Vikas Dudeja
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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- Dido Franceschi
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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- Alan S. Livingstone
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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- Nipun B. Merchant
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
説明
<jats:sec> <jats:title>Objective:</jats:title> <jats:p>To compare the survival outcomes associated with clinical and pathological response in pancreatic ductal adenocarcinoma (PDAC) patients receiving neoadjuvant chemotherapy (NAC) with FOLFIRINOX (FLX) or gemcitabine/nab-paclitaxel (GNP) followed by curative-intent pancreatectomy.</jats:p> </jats:sec> <jats:sec> <jats:title>Background:</jats:title> <jats:p>Newer multiagent NAC regimens have resulted in improved clinical and pathological responses in PDAC; however, the effects of these responses on survival outcomes remain unknown.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Clinicopathological and survival data of PDAC patients treated at 7 academic medical centers were analyzed. Primary outcomes were overall survival (OS), local recurrence-free survival (L-RFS), and metastasis-free survival (MFS) associated with biochemical (CA 19–9 decrease ≥50% vs <50%) and pathological response (complete, pCR; partial, pPR or limited, pLR) following NAC.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Of 274 included patients, 46.4% were borderline resectable, 25.5% locally advanced, and 83.2% had pancreatic head/neck tumors. Vein resection was performed in 34.7% and 30-day mortality was 2.2%. R0 and pCR rates were 82.5% and 6%, respectively. Median, 3-year, and 5-year OS were 32 months, 46.3%, and 30.3%, respectively. OS, L-RFS, and MFS were superior in patients with marked biochemical response (CA 19–9 decrease ≥50% vs <50%; OS: 42.3 vs 24.3 months, <jats:italic toggle="yes">P</jats:italic> < 0.001; L-RFS-27.3 vs 14.1 months, <jats:italic toggle="yes">P</jats:italic> = 0.042; MFS-29.3 vs 13 months, <jats:italic toggle="yes">P</jats:italic> = 0.047) and pathological response [pCR vs pPR vs pLR: OS- not reached (NR) vs 40.3 vs 26.1 months, <jats:italic toggle="yes">P</jats:italic> < 0.001; L-RFS-NR vs 24.5 vs 21.4 months, <jats:italic toggle="yes">P</jats:italic> = 0.044; MFS-NR vs 23.7 vs 20.2 months, <jats:italic toggle="yes">P</jats:italic> = 0.017]. There was no difference in L-RFS, MFS, or OS between patients who received FLX or GNP.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>This large, multicenter study shows that improved biochemical, pathological, and clinical responses associated with NAC FLX or GNP result in improved OS, L-RFS, and MFS in PDAC. NAC with FLX or GNP has similar survival outcomes.</jats:p> </jats:sec>
収録刊行物
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- Annals of Surgery
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Annals of Surgery 270 (3), 400-413, 2019-09
Ovid Technologies (Wolters Kluwer Health)