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Role of surgical resection in the era of FOLFIRINOX for advanced pancreatic cancer.

Abstract

BACKGROUND

The introduction of FOLFIRINOX regimen greatly changed the treatment for advanced pancreatic cancers. However, detailed studies on the clinical effects and factors affecting the prognosis are insufficient. We performed this study to evaluate the effects of FOLFIRINOX and the surgical resection in advanced pancreatic cancer.

METHODS

337 patients with advanced pancreatic cancer who initially received FOLFIRINOX, from January 2011 to December 2017, were retrospectively reviewed. Patients were evaluated according to NCCN guideline, responses after 4-6 cycles of FOLFIRINOX were re-evaluated according to RECIST, and further treatment was decided in the multidisciplinary meeting.

RESULTS

67 (19.9%) patients had borderline resectable pancreatic cancer (BRPC), 135 (40.1%) locally advanced pancreatic cancer (LAPC), and 135 (40.1%) metastatic pancreatic cancer. The median survival period was significantly longer in the surgical group than in the nonsurgical group in each clinical stage, even in metastatic pancreatic cancer, 32 vs. 14, p=.012. In multivariate analysis, metastatic status at diagnosis, progressive disease after FOLFIRINOX, surgical resection, and declined CA19-9 after FOLFIRINOX were significant prognostic factors.

CONCLUSIONS

Surgical treatment greatly affects survival outcomes in advanced pancreatic cancer treated with FOLFIRINOX. Further studies on the optimal indication of operation and the protocol are needed. This article is protected by copyright. All rights reserved.

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  • Authors+Show Affiliations

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    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

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    Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

    Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31218836

    Citation

    Byun, Yoonhyeong, et al. "Role of Surgical Resection in the Era of FOLFIRINOX for Advanced Pancreatic Cancer." Journal of Hepato-biliary-pancreatic Sciences, 2019.
    Byun Y, Han Y, Kang JS, et al. Role of surgical resection in the era of FOLFIRINOX for advanced pancreatic cancer. J Hepatobiliary Pancreat Sci. 2019.
    Byun, Y., Han, Y., Kang, J. S., Choi, Y. J., Kim, H., Kwon, W., ... Jang, J. Y. (2019). Role of surgical resection in the era of FOLFIRINOX for advanced pancreatic cancer. Journal of Hepato-biliary-pancreatic Sciences, doi:10.1002/jhbp.648.
    Byun Y, et al. Role of Surgical Resection in the Era of FOLFIRINOX for Advanced Pancreatic Cancer. J Hepatobiliary Pancreat Sci. 2019 Jun 20; PubMed PMID: 31218836.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Role of surgical resection in the era of FOLFIRINOX for advanced pancreatic cancer. AU - Byun,Yoonhyeong, AU - Han,Youngmin, AU - Kang,Jae Seung, AU - Choi,Yoo Jin, AU - Kim,Hongbeom, AU - Kwon,Wooil, AU - Kim,Sun-Whe, AU - Oh,Do-Youn, AU - Lee,Sang Hyub, AU - Ryu,Ji Kon, AU - Kim,Yong-Tae, AU - Jang,Jin-Young, Y1 - 2019/06/20/ PY - 2019/6/21/entrez KW - Advanced pancreatic cancer KW - FOLFIRINOX KW - Neoadjuvant chemotherapy KW - Pancreatic surgery JF - Journal of hepato-biliary-pancreatic sciences JO - J Hepatobiliary Pancreat Sci N2 - BACKGROUND: The introduction of FOLFIRINOX regimen greatly changed the treatment for advanced pancreatic cancers. However, detailed studies on the clinical effects and factors affecting the prognosis are insufficient. We performed this study to evaluate the effects of FOLFIRINOX and the surgical resection in advanced pancreatic cancer. METHODS: 337 patients with advanced pancreatic cancer who initially received FOLFIRINOX, from January 2011 to December 2017, were retrospectively reviewed. Patients were evaluated according to NCCN guideline, responses after 4-6 cycles of FOLFIRINOX were re-evaluated according to RECIST, and further treatment was decided in the multidisciplinary meeting. RESULTS: 67 (19.9%) patients had borderline resectable pancreatic cancer (BRPC), 135 (40.1%) locally advanced pancreatic cancer (LAPC), and 135 (40.1%) metastatic pancreatic cancer. The median survival period was significantly longer in the surgical group than in the nonsurgical group in each clinical stage, even in metastatic pancreatic cancer, 32 vs. 14, p=.012. In multivariate analysis, metastatic status at diagnosis, progressive disease after FOLFIRINOX, surgical resection, and declined CA19-9 after FOLFIRINOX were significant prognostic factors. CONCLUSIONS: Surgical treatment greatly affects survival outcomes in advanced pancreatic cancer treated with FOLFIRINOX. Further studies on the optimal indication of operation and the protocol are needed. This article is protected by copyright. All rights reserved. SN - 1868-6982 UR - https://www.unboundmedicine.com/medline/citation/31218836/Role_of_surgical_resection_in_the_era_of_FOLFIRINOX_for_advanced_pancreatic_cancer L2 - https://doi.org/10.1002/jhbp.648 DB - PRIME DP - Unbound Medicine ER -