Cargando…

Induction Chemotherapy with FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Simple Scoring System to Predict Effect and Prognosis

BACKGROUND: Effective chemotherapy (CTx) protocols as induction treatment provide increasing opportunities for surgical resection of locally advanced pancreatic cancer (LAPC). Although improved survival after resection of LAPC with CTx has been reported for selected patients, reliable recommendation...

Descripción completa

Detalles Bibliográficos
Autores principales: Tanaka, Masayuki, Heckler, Max, Mihaljevic, André L., Ei, Shigenori, Klaiber, Ulla, Heger, Ulrike, Büchler, Markus W., Hackert, Thilo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10027766/
https://www.ncbi.nlm.nih.gov/pubmed/36153440
http://dx.doi.org/10.1245/s10434-022-12569-y
_version_ 1784909780549107712
author Tanaka, Masayuki
Heckler, Max
Mihaljevic, André L.
Ei, Shigenori
Klaiber, Ulla
Heger, Ulrike
Büchler, Markus W.
Hackert, Thilo
author_facet Tanaka, Masayuki
Heckler, Max
Mihaljevic, André L.
Ei, Shigenori
Klaiber, Ulla
Heger, Ulrike
Büchler, Markus W.
Hackert, Thilo
author_sort Tanaka, Masayuki
collection PubMed
description BACKGROUND: Effective chemotherapy (CTx) protocols as induction treatment provide increasing opportunities for surgical resection of locally advanced pancreatic cancer (LAPC). Although improved survival after resection of LAPC with CTx has been reported for selected patients, reliable recommendations on the indication for conversion surgery after induction treatment are currently lacking. We investigated the factors predictive of prognosis in resected LAPC after FOLFIRINOX. METHODS: Consecutive patients with LAPC undergoing curative resection after FOLFIRINOX between 2011 and 2018 were identified from a prospectively maintained database. Relevant clinical parameters and CT findings were examined. A scoring system was developed based on the ratio of hazard ratios for overall survival of all significant predictors. RESULTS: A total of 62 patients with LAPC who underwent oncologic resection after FOLFIRINOX were analyzed. Tumor shrinkage, tumor density, and postchemotherapy CA19-9 serum levels were independently associated with overall survival (multivariate analysis: HR = 0.31, 0.17, and 0.18, respectively). One, two, and two points were allocated to these three factors in the proposed scoring system, respectively. The median overall survival of patients with a score from 0 to 2 was significantly shorter than that of patients with a score from 3 to 5 (22.1 months vs. 53.2 months, P < 0.001). CONCLUSIONS: Tumor density is a novel predictive marker for the prognosis of patients with resected LAPC after FOLFIRINOX. A simple scoring model incorporating tumor density, the tumor shrinkage rate, and CA 19-9 levels identifies patients with a low score, who may be candidates for additional treatment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-022-12569-y.
format Online
Article
Text
id pubmed-10027766
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-100277662023-03-22 Induction Chemotherapy with FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Simple Scoring System to Predict Effect and Prognosis Tanaka, Masayuki Heckler, Max Mihaljevic, André L. Ei, Shigenori Klaiber, Ulla Heger, Ulrike Büchler, Markus W. Hackert, Thilo Ann Surg Oncol Pancreatic Tumors BACKGROUND: Effective chemotherapy (CTx) protocols as induction treatment provide increasing opportunities for surgical resection of locally advanced pancreatic cancer (LAPC). Although improved survival after resection of LAPC with CTx has been reported for selected patients, reliable recommendations on the indication for conversion surgery after induction treatment are currently lacking. We investigated the factors predictive of prognosis in resected LAPC after FOLFIRINOX. METHODS: Consecutive patients with LAPC undergoing curative resection after FOLFIRINOX between 2011 and 2018 were identified from a prospectively maintained database. Relevant clinical parameters and CT findings were examined. A scoring system was developed based on the ratio of hazard ratios for overall survival of all significant predictors. RESULTS: A total of 62 patients with LAPC who underwent oncologic resection after FOLFIRINOX were analyzed. Tumor shrinkage, tumor density, and postchemotherapy CA19-9 serum levels were independently associated with overall survival (multivariate analysis: HR = 0.31, 0.17, and 0.18, respectively). One, two, and two points were allocated to these three factors in the proposed scoring system, respectively. The median overall survival of patients with a score from 0 to 2 was significantly shorter than that of patients with a score from 3 to 5 (22.1 months vs. 53.2 months, P < 0.001). CONCLUSIONS: Tumor density is a novel predictive marker for the prognosis of patients with resected LAPC after FOLFIRINOX. A simple scoring model incorporating tumor density, the tumor shrinkage rate, and CA 19-9 levels identifies patients with a low score, who may be candidates for additional treatment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-022-12569-y. Springer International Publishing 2022-09-24 2023 /pmc/articles/PMC10027766/ /pubmed/36153440 http://dx.doi.org/10.1245/s10434-022-12569-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Pancreatic Tumors
Tanaka, Masayuki
Heckler, Max
Mihaljevic, André L.
Ei, Shigenori
Klaiber, Ulla
Heger, Ulrike
Büchler, Markus W.
Hackert, Thilo
Induction Chemotherapy with FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Simple Scoring System to Predict Effect and Prognosis
title Induction Chemotherapy with FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Simple Scoring System to Predict Effect and Prognosis
title_full Induction Chemotherapy with FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Simple Scoring System to Predict Effect and Prognosis
title_fullStr Induction Chemotherapy with FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Simple Scoring System to Predict Effect and Prognosis
title_full_unstemmed Induction Chemotherapy with FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Simple Scoring System to Predict Effect and Prognosis
title_short Induction Chemotherapy with FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Simple Scoring System to Predict Effect and Prognosis
title_sort induction chemotherapy with folfirinox for locally advanced pancreatic cancer: a simple scoring system to predict effect and prognosis
topic Pancreatic Tumors
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10027766/
https://www.ncbi.nlm.nih.gov/pubmed/36153440
http://dx.doi.org/10.1245/s10434-022-12569-y
work_keys_str_mv AT tanakamasayuki inductionchemotherapywithfolfirinoxforlocallyadvancedpancreaticcancerasimplescoringsystemtopredicteffectandprognosis
AT hecklermax inductionchemotherapywithfolfirinoxforlocallyadvancedpancreaticcancerasimplescoringsystemtopredicteffectandprognosis
AT mihaljevicandrel inductionchemotherapywithfolfirinoxforlocallyadvancedpancreaticcancerasimplescoringsystemtopredicteffectandprognosis
AT eishigenori inductionchemotherapywithfolfirinoxforlocallyadvancedpancreaticcancerasimplescoringsystemtopredicteffectandprognosis
AT klaiberulla inductionchemotherapywithfolfirinoxforlocallyadvancedpancreaticcancerasimplescoringsystemtopredicteffectandprognosis
AT hegerulrike inductionchemotherapywithfolfirinoxforlocallyadvancedpancreaticcancerasimplescoringsystemtopredicteffectandprognosis
AT buchlermarkusw inductionchemotherapywithfolfirinoxforlocallyadvancedpancreaticcancerasimplescoringsystemtopredicteffectandprognosis
AT hackertthilo inductionchemotherapywithfolfirinoxforlocallyadvancedpancreaticcancerasimplescoringsystemtopredicteffectandprognosis