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KMID : 0939920230550030956
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대한암학회지
2023 Volume.55 No. 3 p.956 ~ p.968
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Survival Benefit of Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma Who Underwent Surgery Following Neoadjuvant FOLFIRINOX
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Lee So-Heun
Hwang Dae-Wook
Yoo Chang-Hoon
Kim Kyu-pyo
Kang So-Ra
Jeong Jae-Ho
Oh Dong-Wook
Song Tae-Jun
Lee Sang-Soo
Park Do-Hyun
Seo Dong-Wan
Park Jin-hong
Song Ki-Byung
Lee Jae-Hoon
Lee Woo-Hyung
Park Ye-Jong
Kwak Bong-Jun
Chang Heung-Moon
Ryoo Baek-Yeol
Kim Song-Cheol
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Abstract
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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.
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KEYWORD
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Pancreatic neoplasms, Adenocarcinoma, Adjuvant chemotherapy, Neoadjuvant therapy, FOLFIRINOX, Propensity score, Prognosis, Lymph nodes
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