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

医学 叶黄素 化疗 吉西他滨 养生 新辅助治疗 内科学 外科 胰腺切除术 肿瘤科 癌症 乳腺癌 奥沙利铂 胰腺 结直肠癌
作者
Gabriel D. Ivey,Sami Shoucair,Daniel Delitto,Joseph R. Habib,Benedict Kinny‐Köster,Christopher R. Shubert,Kelly J. Lafaro,John L. Cameron,William R. Burns,Richard A. Burkhart,Elizabeth Thompson,Amol Narang,Lei Zheng,Christopher L. Wolfgang,Jin He
出处
期刊:World Journal of Surgery [Springer Science+Business Media]
卷期号:46 (11): 2751-2759 被引量:7
标识
DOI:10.1007/s00268-022-06667-x
摘要

Abstract 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.
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