Optimizing Indications for Conversion Surgery Based on Analysis of 454 Consecutive Japanese Cases with Unresectable Pancreatic Cancer Who Received Modified FOLFIRINOX or Gemcitabine Plus Nab-paclitaxel: A Single-Center Retrospective Study.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
01
09
2021
accepted:
07
02
2022
pubmed:
17
3
2022
medline:
7
7
2022
entrez:
16
3
2022
Statut:
ppublish
Résumé
The prognosis of initially unresectable pancreatic cancer (UR-PC) has improved since the introduction of FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (GNP) treatment. Nonetheless, the indications and optimal timing for conversion to resection remain unclear for UR-PC. The aim of this study is to evaluate the characteristics of cases with initially UR-PC who received modified FFX or GNP treatment. This retrospective study reviewed 454 consecutive Japanese UR-PC cases who received modified FFX/GNP treatment. Cases were categorized according to resection status, and overall survival (OS) was evaluated using a multivariable prognostic scoring model (0-4 points, higher score indicating more favorable prognostic factors). The overall resection rate was 16% for locally advanced UR-PC (UR-LA) and 5% for metastatic UR-PC (UR-M). The resection group had better OS than the nonresection group (median OS time: not reached versus 13.0 months, P < 0.001). The independent prognostic factors were normalized CA19-9 concentration, modified Glasgow prognostic score of 0, tumor shrinkage after chemotherapy, chemotherapy duration ≥ 8 months, and resection. Cases were grouped according to their prognostic score, and the results suggested that candidates for resection might have prognostic scores of 4 points in UR-M cases or 2-4 points in UR-LA cases. Stratification according to prognostic score was useful in predicting the outcomes of UR-PC cases and may aid in identifying cases who might benefit from surgical treatment after responding to chemotherapy.
Sections du résumé
BACKGROUND
BACKGROUND
The prognosis of initially unresectable pancreatic cancer (UR-PC) has improved since the introduction of FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (GNP) treatment. Nonetheless, the indications and optimal timing for conversion to resection remain unclear for UR-PC. The aim of this study is to evaluate the characteristics of cases with initially UR-PC who received modified FFX or GNP treatment.
METHODS
METHODS
This retrospective study reviewed 454 consecutive Japanese UR-PC cases who received modified FFX/GNP treatment. Cases were categorized according to resection status, and overall survival (OS) was evaluated using a multivariable prognostic scoring model (0-4 points, higher score indicating more favorable prognostic factors).
RESULTS
RESULTS
The overall resection rate was 16% for locally advanced UR-PC (UR-LA) and 5% for metastatic UR-PC (UR-M). The resection group had better OS than the nonresection group (median OS time: not reached versus 13.0 months, P < 0.001). The independent prognostic factors were normalized CA19-9 concentration, modified Glasgow prognostic score of 0, tumor shrinkage after chemotherapy, chemotherapy duration ≥ 8 months, and resection. Cases were grouped according to their prognostic score, and the results suggested that candidates for resection might have prognostic scores of 4 points in UR-M cases or 2-4 points in UR-LA cases.
CONCLUSIONS
CONCLUSIONS
Stratification according to prognostic score was useful in predicting the outcomes of UR-PC cases and may aid in identifying cases who might benefit from surgical treatment after responding to chemotherapy.
Identifiants
pubmed: 35294658
doi: 10.1245/s10434-022-11503-6
pii: 10.1245/s10434-022-11503-6
doi:
Substances chimiques
130-nm albumin-bound paclitaxel
0
Albumins
0
folfirinox
0
Oxaliplatin
04ZR38536J
Deoxycytidine
0W860991D6
Irinotecan
7673326042
Paclitaxel
P88XT4IS4D
Leucovorin
Q573I9DVLP
Fluorouracil
U3P01618RT
Gemcitabine
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5038-5050Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. Society of Surgical Oncology.
Références
Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913–21.
doi: 10.1158/0008-5472.CAN-14-0155
Egawa S, Toma H, Ohigashi H, et al. Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society. Pancreas. 2012;41(7):985–92.
doi: 10.1097/MPA.0b013e318258055c
Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. The Lancet. 2011;378(9791):607–20.
doi: 10.1016/S0140-6736(10)62307-0
Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369(18):1691–703.
doi: 10.1056/NEJMoa1304369
Conroy T DF, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa-Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M; Groupe Tumeurs Digestives of Unicancer; PRODIGE Intergroup. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817-1825.
Satoi S, Yamamoto T, Yamaki S, Sakaguchi T, Sekimoto M. Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma. Ann Gastroenterol Surg. 2020;4(1):6–13.
doi: 10.1002/ags3.12295
Bednar F, Zenati MS, Steve J, et al. Analysis of predictors of resection and survival in locally advanced stage III pancreatic cancer: does the nature of chemotherapy regimen influence outcomes? Ann Surg Oncol. 2017;24(5):1406–13.
doi: 10.1245/s10434-016-5707-0
Blazer M, Wu C, Goldberg RM, et al. Neoadjuvant modified (m) FOLFIRINOX for locally advanced unresectable (LAPC) and borderline resectable (BRPC) adenocarcinoma of the pancreas. Ann Surg Oncol. 2015;22(4):1153–9.
doi: 10.1245/s10434-014-4225-1
Marthey L, Sa-Cunha A, Blanc JF, et al. FOLFIRINOX for locally advanced pancreatic adenocarcinoma: results of an AGEO multicenter prospective observational cohort. Ann Surg Oncol. 2015;22(1):295–301.
doi: 10.1245/s10434-014-3898-9
Motoi FTT, Maeda S, Ariake K, Masuda K, Ishida M, Fukase K, Mizuma M, Ohtsuka H, Sakata N, Hayashi H, Nakagawa K, Morikawa T, Naitoh T, Unno M. Multidisciplinary Therapy with gemcitabine and nab-paclitaxel for unresectable pancreatic cancer. Gan To Kagaku Ryoho. 2017;44(12):1241–4.
pubmed: 29394594
Napolitano F, Formisano L, Giardino A, et al. Neoadjuvant treatment in locally advanced pancreatic cancer (LAPC) patients with FOLFIRINOX or gemcitabine nabpaclitaxel: a single-center experience and a literature review. Cancers (Basel). 2019;11(7).
Natsume S, Shimizu Y, Senda Y, et al. Conversion surgery only for highly selected patients with unresectable pancreatic cancer: a satisfactory outcome in exchange for a lower resection rate. Surg Today. 2019;49(8):670–7.
doi: 10.1007/s00595-019-01776-y
Nitsche U, Wenzel P, Siveke JT, et al. Resectability after first-line FOLFIRINOX in initially unresectable locally advanced pancreatic cancer: a single-center experience. Ann Surg Oncol. 2015;22(Suppl 3):S1212-1220.
doi: 10.1245/s10434-015-4851-2
Yoo C, Shin SH, Kim KP, et al. Clinical outcomes of conversion surgery after neoadjuvant chemotherapy in patients with borderline resectable and locally advanced unresectable pancreatic cancer: a single-center, retrospective analysis. Cancers (Basel). 26 2019;11(3).
Tempero MA, Malafa MP, Chiorean EG, et al. Pancreatic adenocarcinoma, version 1.2019. J Natl Compr Canc Netw. 2019;17(3):202-210.
Ozaka M, Ishii H, Sato T, et al. A phase II study of modified FOLFIRINOX for chemotherapy-naive patients with metastatic pancreatic cancer. Cancer Chemother Pharmacol. 2018;81(6):1017–23.
doi: 10.1007/s00280-018-3577-9
Sato T, Saiura A, Inoue Y, Takahashi Y, Arita J, Takemura N. Distal pancreatectomy with en bloc resection of the celiac axis with preservation or reconstruction of the left gastric artery in patients with pancreatic body cancer. World J Surg. 2016;40(9):2245–53.
doi: 10.1007/s00268-016-3550-x
Inoue Y, Saiura A, Oba A, et al. Optimal extent of superior mesenteric artery dissection during pancreaticoduodenectomy for pancreatic cancer: balancing surgical and oncological safety. J Gastrointest Surg. 2019;23(7):1373–83.
doi: 10.1007/s11605-018-3995-3
Inoue Y, Saiura A, Yoshioka R, et al. Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg. 2015;262(6):1092–101.
doi: 10.1097/SLA.0000000000001065
Sato T, Inoue Y, Takahashi Y, et al. Distal pancreatectomy with celiac axis resection combined with reconstruction of the left gastric artery. J Gastrointest Surg. 2017;21(5):910–7.
doi: 10.1007/s11605-017-3366-5
Garcea G, Ladwa N, Neal CP, Metcalfe MS, Dennison AR, Berry DP. Preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma. World J Surg. 2011;35(4):868–72.
doi: 10.1007/s00268-011-0984-z
Proctor MJ, Morrison DS, Talwar D, et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer. 2011;104(4):726–34.
doi: 10.1038/sj.bjc.6606087
Stotz M, Gerger A, Eisner F, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109(2):416–21.
doi: 10.1038/bjc.2013.332
Oba A, Inoue Y, Ono Y, et al. Radiologically occult metastatic pancreatic cancer: how can we avoid unbeneficial resection? Langenbecks Arch Surg. 2020;405(1):35–41.
doi: 10.1007/s00423-019-01846-2
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplantation. 2012;48(3):452–8.
doi: 10.1038/bmt.2012.244
Satoi S, Yamaue H, Kato K, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2013;20(6):590–600.
doi: 10.1007/s00534-013-0616-0
Michelakos T, Pergolini I, Castillo CF, et al. Predictors of resectability and survival in patients with borderline and locally advanced pancreatic cancer who underwent neoadjuvant treatment with FOLFIRINOX. Ann Surg. 2019;269(4):733–40.
doi: 10.1097/SLA.0000000000002600
Rangelova E, Wefer A, Persson S, et al. Surgery improves survival after neoadjuvant therapy for borderline and locally advanced pancreatic cancer: a single institution experience. Ann Surg. 2021;273(3):579–86.
doi: 10.1097/SLA.0000000000003301
Mahaseth H, Brutcher E, Kauh J, et al. Modified FOLFIRINOX regimen with improved safety and maintained efficacy in pancreatic adenocarcinoma. Pancreas. 2013;42(8):1311–5.
doi: 10.1097/MPA.0b013e31829e2006
Hartwig W, Strobel O, Hinz U, et al. CA19-9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol. 2013;20(7):2188–96.
doi: 10.1245/s10434-012-2809-1
Ushida Y, Inoue Y, Ito H, et al. High CA19-9 level in resectable pancreatic cancer is a potential indication of neoadjuvant treatment. Pancreatology. 2020.
Williams JL, Kadera BE, Nguyen AH, et al. CA19-9 Normalization during pre-operative treatment predicts longer survival for patients with locally progressed pancreatic cancer. J Gastrointest Surg. 2016;20(7):1331–42.
doi: 10.1007/s11605-016-3149-4
Truty MJ, Kendrick ML, Nagorney DM, et al. Factors predicting response, perioperative outcomes, and survival following total neoadjuvant therapy for borderline/locally advanced pancreatic cancer. Ann Surg. 2019.
Cai B, Lu Z, Neoptolemos JP, et al. Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study. Langenbecks Arch Surg. 2021.
Loos M, Kester T, Klaiber U, et al. Arterial resection in pancreatic cancer surgery: effective after a learning curve. Ann Surg. 2020.
Jang JY, Kang MJ, Heo JS, et al. A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer. Ann Surg. 259(4):656-664.
Nimura Y, Nagino M, Takao S, et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci. 2012;19(3):230–41.
doi: 10.1007/s00534-011-0466-6
Amano H, Miura F, Toyota N, et al. Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepatobiliary Pancreat Surg. 16(6):850-857.
Jegatheeswaran S, Baltatzis M, Jamdar S, Siriwardena AK. Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. HPB (Oxford). 2017;19(6):483–90.
doi: 10.1016/j.hpb.2017.02.437
Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg. 2008;247(2):300–9.
doi: 10.1097/SLA.0b013e31815aab22
Bachellier P, Addeo P, Faitot F, Nappo G, Dufour P. Pancreatectomy with arterial resection for pancreatic adenocarcinoma: how can it be done safely and with which outcomes?: a single institution’s experience with 118 patients. Ann Surg. 2020;271(5):932–40.
doi: 10.1097/SLA.0000000000003010
Del Chiaro M, Rangelova E, Halimi A, et al. Pancreatectomy with arterial resection is superior to palliation in patients with borderline resectable or locally advanced pancreatic cancer. HPB (Oxford). 2019;21(2):219–25.
doi: 10.1016/j.hpb.2018.07.017
Hackert T, Niesen W, Hinz U, et al. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol. 2017;43(2):358–63.
doi: 10.1016/j.ejso.2016.10.023
Frigerio I, Regi P, Giardino A, et al. Downstaging in stage IV pancreatic cancer: a new population eligible for surgery? Ann Surg Oncol. 2017;24(8):2397–403.
doi: 10.1245/s10434-017-5885-4
Wright GP, Poruk KE, Zenati MS, et al. Primary tumor resection following favorable response to systemic chemotherapy in stage IV pancreatic adenocarcinoma with synchronous metastases: a bi-institutional analysis. J Gastrointest Surg. 2016;20(11):1830–5.
doi: 10.1007/s11605-016-3256-2
Sakaguchi T, Valente R, Tanaka K, Satoi S, Del Chiaro M. Surgical treatment of metastatic pancreatic ductal adenocarcinoma: A review of current literature. Pancreatology. 2019;19(5):672–80.
doi: 10.1016/j.pan.2019.05.466
Takeda T, Sasaki T, Mie T, et al. Improved prognosis of pancreatic cancer patients with peritoneal metastasis. Pancreatology. 2021.
Satoi S, Fujii T, Yanagimoto H, et al. Multicenter phase II study of intravenous and intraperitoneal paclitaxel with S-1 for pancreatic ductal adenocarcinoma patients with peritoneal metastasis. Ann Surg. 2017;265(2):397–401.
doi: 10.1097/SLA.0000000000001705
Yamada S, Fujii T, Yamamoto T, et al. Phase I/II study of adding intraperitoneal paclitaxel in patients with pancreatic cancer and peritoneal metastasis. Br J Surg. 2020;107(13):1811–7.
doi: 10.1002/bjs.11792