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

doi:10.1245/s10434-022-12387-2

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

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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 language	English
Pages (from-to)	1463-1473
Number of pages	11
Journal	Annals of Surgical Oncology
Volume	30
Issue number	3
DOIs	https://doi.org/10.1245/s10434-022-12387-2
Publication status	Published - Mar 2023

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@article{28a7ead3f67d4645a3bfda1404308d2c,

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

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.",

author = "{van Veldhuisen}, Eran and Sjors Klompmaker and Janssen, {Quisette P} and Hilal, {Mohammed Abu} and Adnan Alseidi and Alberto Balduzzi and Gianpaolo Balzano and Claudio Bassi and Frederik Berrevoet and Morgan Bonds and Busch, {Olivier R} and Giovanni Butturini and Conlon, {Kevin C} and Frigerio, {Isabella M} and Fusai, {Giuseppe K} and Johan Gagni{\`e}re and Oonagh Griffin and Thilo Hackert and Asif Halimi and Tobias Keck and J{\"o}rg Kleeff and Ulla Klaiber and Labori, {Knut J} and Mickael Lesurtel and Giuseppe Malleo and Marino, {Marco V} and Molenaar, {I Quintus} and Mortensen, {Michael B} and Andrej Nikov and Michele Pagnanelli and Rupaly Pand{\'e} and Per Pfeiffer and Daniel Pietrasz and Elena Rangelova and Roberts, {Keith J} and Cunha, {Antonio Sa} and Roberto Salvia and Oliver Strobel and Timo Tarvainen and Wilmink, {Johanna W} and Koerkamp, {Bas Groot} and Besselink, {Marc G}",

note = "Funding Information: The authors acknowledge the scientific and research committee of the European-African Hepato-Pancreato-Biliary Association for supporting this study. The authors also acknowledge Alain Sauvanet (Beaujon Hospital, Clichy, France), Lysiane Marthey (Antoine B{\'e}cl{\`e}re Hospital, Clamart, France), Christophe Laurent (H{\^o}pital Haut L{\'e}v{\^e}que, CHU de Bordeaux, Pessac, France), Nicolas R{\'e}genet (Nantes Hospital, Nantes, France), Romain Coriat (Cochin Hospital, Paris, France), Julien Taieb (Georges Pompidou European Hospital, Paris, France), Olivier Turini (Institut Pauli Calmettes, Marseille, France), Vincent Dubray (H{\^o}pital Huriez Lille, Lille, France), Raphael Bourdariat (Jean Mermoz Hospital, Lyon, France), Jean Baptiste Bachet (Piti{\'e} Salp{\^e}tri{\`e}re Hospital, Paris, France), and Lilian Schwartz (Charles Nicolle Hospital, Rouen, France) for contributing to the current study. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2023",

month = mar,

doi = "10.1245/s10434-022-12387-2",

language = "English",

volume = "30",

pages = "1463--1473",

journal = "Annals of Surgical Oncology",

issn = "1068-9265",

publisher = "Springer New York",

number = "3",

}

TY - JOUR

T1 - Surgical and Oncological Outcomes After Preoperative FOLFIRINOX Chemotherapy in Resected Pancreatic Cancer

T2 - An International Multicenter Cohort Study

AU - van Veldhuisen, Eran

AU - Klompmaker, Sjors

AU - Janssen, Quisette P

AU - Hilal, Mohammed Abu

AU - Alseidi, Adnan

AU - Balduzzi, Alberto

AU - Balzano, Gianpaolo

AU - Bassi, Claudio

AU - Berrevoet, Frederik

AU - Bonds, Morgan

AU - Busch, Olivier R

AU - Butturini, Giovanni

AU - Conlon, Kevin C

AU - Frigerio, Isabella M

AU - Fusai, Giuseppe K

AU - Gagnière, Johan

AU - Griffin, Oonagh

AU - Hackert, Thilo

AU - Halimi, Asif

AU - Keck, Tobias

AU - Kleeff, Jörg

AU - Klaiber, Ulla

AU - Labori, Knut J

AU - Lesurtel, Mickael

AU - Malleo, Giuseppe

AU - Marino, Marco V

AU - Molenaar, I Quintus

AU - Mortensen, Michael B

AU - Nikov, Andrej

AU - Pagnanelli, Michele

AU - Pandé, Rupaly

AU - Pfeiffer, Per

AU - Pietrasz, Daniel

AU - Rangelova, Elena

AU - Roberts, Keith J

AU - Cunha, Antonio Sa

AU - Salvia, Roberto

AU - Strobel, Oliver

AU - Tarvainen, Timo

AU - Wilmink, Johanna W

AU - Koerkamp, Bas Groot

AU - Besselink, Marc G

N1 - Funding Information: The authors acknowledge the scientific and research committee of the European-African Hepato-Pancreato-Biliary Association for supporting this study. The authors also acknowledge Alain Sauvanet (Beaujon Hospital, Clichy, France), Lysiane Marthey (Antoine Béclère Hospital, Clamart, France), Christophe Laurent (Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France), Nicolas Régenet (Nantes Hospital, Nantes, France), Romain Coriat (Cochin Hospital, Paris, France), Julien Taieb (Georges Pompidou European Hospital, Paris, France), Olivier Turini (Institut Pauli Calmettes, Marseille, France), Vincent Dubray (Hôpital Huriez Lille, Lille, France), Raphael Bourdariat (Jean Mermoz Hospital, Lyon, France), Jean Baptiste Bachet (Pitié Salpêtrière Hospital, Paris, France), and Lilian Schwartz (Charles Nicolle Hospital, Rouen, France) for contributing to the current study. Publisher Copyright: © 2022, The Author(s).

PY - 2023/3

Y1 - 2023/3

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85144725080&partnerID=8YFLogxK

U2 - 10.1245/s10434-022-12387-2

DO - 10.1245/s10434-022-12387-2

M3 - Article

C2 - 36539580

SN - 1068-9265

VL - 30

SP - 1463

EP - 1473

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 3

ER -

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

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