Surgical and Oncological Outcomes After Preoperative FOLFIRINOX Chemotherapy in Resected Pancreatic Cancer: An International Multicenter Cohort Study

Eran van Veldhuisen, Sjors Klompmaker, on behalf of the Scientific Committee of the European-African Hepato-Pancreato-Biliary Association, Quisette P. Janssen, Mohammed Abu Hilal, Adnan Alseidi, Alberto Balduzzi, Gianpaolo Balzano, Claudio Bassi, Frederik Berrevoet, Morgan Bonds, Olivier R. Busch, Giovanni Butturini, Kevin C. Conlon, Isabella M. Frigerio, Giuseppe K. Fusai, Johan Gagnière, Oonagh Griffin, Thilo Hackert, Asif HalimiTobias Keck, Jörg Kleeff, Ulla Klaiber, Knut J. Labori, Mickael Lesurtel, Giuseppe Malleo, Marco V. Marino, I. Quintus Molenaar, Michael B. Mortensen, Andrej Nikov, Michele Pagnanelli, Rupaly Pandé, Per Pfeiffer, Daniel Pietrasz, Elena Rangelova, Keith J. Roberts, Antonio Sa Cunha, Roberto Salvia, Oliver Strobel, Timo Tarvainen, Johanna W. Wilmink, Bas Groot Koerkamp, Marc G. Besselink*, Alain Sauvanet, Lysiane Marthey, Lysiane Marthey, Christophe Laurent, Nicolas Régenet, Romain Coriat, Julien Taieb, Olivier Turini

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background. Preoperative FOLFIRINOX chemotherapy is increasingly administered to patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) to improve overall survival (OS). Multicenter studies reporting on the impact from the number of preoperative cycles and the use of adjuvant chemotherapy in relation to outcomes in this setting are lacking. This study aimed to assess the outcome of pancreatectomy after preoperative FOLFIRINOX, including predictors of OS.Methods. This international multicenter retrospective cohort study included patients from 31 centers in 19 European countries and the United States undergoing pancreatectomy after preoperative FOLFIRINOX chemotherapy (2012-2016). The primary end point was OS from diagnosis. Survival was assessed using Kaplan-Meier analysis and Cox regression.Results. The study included 423 patients who underwent pancreatectomy after a median of six (IQR 5-8) preoperative cycles of FOLFIRINOX. Postoperative major morbidity occurred for 88 (20.8%) patients and 90-day mortality for 12 (2.8%) patients. An R0 resection was achieved for 243 (57.4%) patients, and 259 (61.2%) patients received adjuvant chemotherapy. The median OS was 38 months (95% confidence interval [CI] 34-42 months) for BRPC and 33 months (95% CI 27-45 months) for LAPC. Overall survival was significantly associated with R0 resection (hazard ratio [HR] 1.63; 95% CI 1.20-2.20) and tumor differentiation (HR 1.43; 95% CI 1.08-1.91). Neither the number of preoperative chemotherapy cycles nor the use adjuvant chemotherapy was associated with OS.Conclusions. This international multicenter study found that pancreatectomy after FOLFIRINOX chemotherapy is associated with favorable outcomes for patients with BRPC and those with LAPC. Future studies should confirm that the number of neoadjuvant cycles and the use adjuvant chemotherapy have no relation to OS after resection.
Original languageEnglish
Pages (from-to)1463-1473
Number of pages11
JournalAnnals of Surgical Oncology
Volume30
Issue number3
Early online dateDec 2022
DOIs
Publication statusPublished - Mar 2023

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