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Background <p>The use of multiagent FOLFIRINOX chemotherapy for pancreatic adenocarcinoma in a neoadjuvant setting has been associated with an increased rate of complete pathological response (CPR) after surgery. This study investigated the long-term outcomes of patients with CPR in a multicenter setting to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS).</p> Methods <p>This retrospective cohort study examined biopsy-proven pancreatic adenocarcinomas with CPR after neoadjuvant chemotherapy or chemoradiotherapy and surgery, between January 2006 and December 2023 across 22 French and&#xa0; 2 Belgian centers. Cox analyses were used to identify prognostic factors of OS and RFS.</p> Results <p>There were 101 patients with CPR after chemotherapy (<i>n</i> = 58, 57.4%) and chemoradiotherapy (<i>n</i> = 43, 42.6%) followed by surgery. Neoadjuvant FOLFIRINOX was used in 90% of patients. The median OS after surgery was 177 months (95% confidence interval (CI) 58.9–177 months) with 1-, 3-, 5-, and 10-year OS rates of 93%, 75%, 63%, and 51%, respectively. The median RFS was 67.8 months (95% CI:34.4–NR) with 1-, 3-, 5-, and 10-year RFS rates of 83%, 58%, 54%, and 49%, respectively. The multivariate Cox analysis of OS and RFS showed that preoperative radiotherapy was an independent negative prognostic factor for OS (hazard ratio (HR) 2.51; 95% CI 1.00–6.30; <i>p</i> = 0.03) and RFS (HR 2.62; 95% CI 1.27–5.41; <i>p</i> = 0.009).</p> Conclusions <p>Complete pathologic response after neoadjuvant treatment is associated with remarkable long-term survival that is usually not seen after the resection of pancreatic adenocarcinomas. One-third of the patients still experienced disease recurrence, which was more common in those receiving preoperative chemoradiotherapy.</p>

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Prognosis Associated with Complete Pathological Response Following Neoadjuvant Treatment for PancreaTic AdenOcarciNOma in the FOFLIRINOX Era: the Multicenter TONO Study

  • 期刊论文

  • 发表日期：

    2025年1月8日

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  • Pietro Addeo,
  • Milena Muzzolini,
  • Christophe Laurent,
  • Bruno Heyd,
  • Alain Sauvanet,
  • Jonathan Garnier,
  • Marie Sophie Alfano,
  • Sebastien Gaujoux,
  • Charles De Ponthaud,
  • Ugo Marchese,
  • Doris Da Silva,
  • Emmanuel Buc,
  • Regis Souche,
  • Jean Michel Fabre,
  • Pierre-Emanuel Colombo,
  • Lorenzo Ferre,
  • Maxime Foguenne,
  • Catherine Hubert,
  • Mehdi El Amrani,
  • Stephanie Truant,
  • Lilian Schwartz,
  • Nicolas Regenet,
  • Aurelien Dupre,
  • Raffaele Brustia,
  • Rim Cherif,
  • Julie Navez,
  • Benjamin Darnis,
  • Olivier Facy,
  • Robin Grellet,
  • Guillaume Piessen,
  • Julie Veziant,
  • Rami Rhaiem,
  • Reza Kianmanesh,
  • Elena Fernandez-De-Sevilla,
  • Maximiliano Gelli,
  • Abdelkader Taibi,
  • Pauline Georges,
  • Jean Yves Mabrut,
  • Mickael Lesurtel,
  • Alexandre Doussot,
  • Philippe Bachellier

摘要

Background

The use of multiagent FOLFIRINOX chemotherapy for pancreatic adenocarcinoma in a neoadjuvant setting has been associated with an increased rate of complete pathological response (CPR) after surgery. This study investigated the long-term outcomes of patients with CPR in a multicenter setting to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS).

Methods

This retrospective cohort study examined biopsy-proven pancreatic adenocarcinomas with CPR after neoadjuvant chemotherapy or chemoradiotherapy and surgery, between January 2006 and December 2023 across 22 French and  2 Belgian centers. Cox analyses were used to identify prognostic factors of OS and RFS.

Results

There were 101 patients with CPR after chemotherapy (n = 58, 57.4%) and chemoradiotherapy (n = 43, 42.6%) followed by surgery. Neoadjuvant FOLFIRINOX was used in 90% of patients. The median OS after surgery was 177 months (95% confidence interval (CI) 58.9–177 months) with 1-, 3-, 5-, and 10-year OS rates of 93%, 75%, 63%, and 51%, respectively. The median RFS was 67.8 months (95% CI:34.4–NR) with 1-, 3-, 5-, and 10-year RFS rates of 83%, 58%, 54%, and 49%, respectively. The multivariate Cox analysis of OS and RFS showed that preoperative radiotherapy was an independent negative prognostic factor for OS (hazard ratio (HR) 2.51; 95% CI 1.00–6.30; p = 0.03) and RFS (HR 2.62; 95% CI 1.27–5.41; p = 0.009).

Conclusions

Complete pathologic response after neoadjuvant treatment is associated with remarkable long-term survival that is usually not seen after the resection of pancreatic adenocarcinomas. One-third of the patients still experienced disease recurrence, which was more common in those receiving preoperative chemoradiotherapy.