Cancer Res Treat.  2023 Jul;55(3):956-968. 10.4143/crt.2022.409.

Survival Benefit of Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma Who Underwent Surgery Following Neoadjuvant FOLFIRINOX

• Lee SH
• Hwang DW
• Yoo C
• Kim Kp
• Kang S
• Jeong JH
• Oh D
• Song TJ
• Lee SS
• Park DH
• Seo DW
• Park Jh
• Song KB
• Lee JH
• Lee W
• Park Y
• Kwak BJ
• Chang HM
• Ryoo BY
• Kim SC

• KMID: 2544176
• DOI: http://doi.org/10.4143/crt.2022.409

Abstract

Purpose
The benefit of adjuvant chemotherapy following curative-intent surgery in pancreatic ductal adenocarcinoma (PDAC) patients who had received neoadjuvant FOLFIRINOX is unclear. This study aimed to assess the survival benefit of adjuvant chemotherapy in this patient population.
Materials and Methods
This retrospective study included 218 patients with localized non-metastatic PDAC who received neoadjuvant FOLFIRINOX and underwent curative-intent surgery (R0 or R1) between January 2017 and December 2020. The association of adjuvant chemotherapy with disease-free survival (DFS) and overall survival (OS) was evaluated in overall patients and in the propensity score matched (PSM) cohort. Subgroup analysis was conducted according to the pathology-proven lymph node status.
Results
Adjuvant chemotherapy was administered to 149 patients (68.3%). In the overall cohort, the adjuvant chemotherapy group had significantly improved DFS and OS compared to the observation group (DFS: median, 13.8 months [95% confidence interval (CI), 11.0 to 19.1] vs. 8.2 months [95% CI, 6.5 to 12.0]; p < 0.001; and OS: median, 38.0 months [95% CI, 32.2 to not assessable] vs. 25.7 months [95% CI, 18.3 to not assessable]; p=0.005). In the PSM cohort of 57 matched pairs of patients, DFS and OS were better in the adjuvant chemotherapy group than in the observation group (p < 0.001 and p=0.038, respectively). In the multivariate analysis, adjuvant chemotherapy was a significant favorable prognostic factor (vs. observation; DFS: hazard ratio [HR], 0.51 [95% CI, 0.36 to 0.71; p < 0.001]; OS: HR, 0.45 [95% CI, 0.29 to 0.71; p < 0.001]).
Conclusion
Among PDAC patients who underwent surgery following neoadjuvant FOLFIRINOX, adjuvant chemotherapy may be associated with improved survival. Randomized studies should be conducted to validate this finding.

Keyword

Pancreatic neoplasms; Adenocarcinoma; Adjuvant chemotherapy; Neoadjuvant therapy; FOLFIRINOX; Propensity score; Prognosis; Lymph nodes

Figure

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  Fig. 1 Survival outcomes according to adjuvant chemotherapy in the overall (unmatched) cohort. (A) Disease-free survival in overall patients. (B) Overall survival in overall patients. (C) Disease-free survival in patients with positive lymph nodes. (D) Overall survival in patients with positive lymph nodes. (E) Disease-free survival in patients with negative lymph nodes. (F) Overall survival in patients with negative lymph nodes. CI, confidence interval; NA, not assessable.

• 

  Fig. 2 Survival outcomes according to adjuvant chemotherapy in the matched cohort. (A) Disease-free survival in overall patients. (B) Overall survival in overall patients. (C) Disease-free survival in patients with positive lymph nodes. (D) Overall survival in patients with positive lymph nodes. (E) Disease-free survival in patients with negative lymph nodes. (F) Overall survival in patients with negative lymph nodes. CI, confidence interval; NA, not assessable.

Reference

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