Details

Autor(en) / Beteiligte

• Bednar, Filip
• Zenati, Mazen S.
• Steve, Jennifer
• Winters, Sharon
• Ocuin, Lee M.
• Bahary, Nathan
• Hogg, Melissa E.
• Zeh, Herbert J.
• Zureikat, Amer H.

Titel

Analysis of Predictors of Resection and Survival in Locally Advanced Stage III Pancreatic Cancer: Does the Nature of Chemotherapy Regimen Influence Outcomes?

Ist Teil von

• Annals of surgical oncology, 2017-05, Vol.24 (5), p.1406-1413

Ort / Verlag

Cham: Springer International Publishing

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Locally advanced unresectable pancreatic cancer (LAPC) historically portends a poor prognosis. FOLFIRINOX and gemcitabine/nab-paclitaxel have proven effective in the metastatic setting. We sought to evaluate the outcomes of these regimens compared with older regimens in LAPC. Methods A retrospective, single institutional review of all consecutive LAPC treated with “new” (FOLFIRINOX and/or gemcitabine/nab-paclitaxel) and “old” (gemcitabine or 5-FU) chemotherapy from 2010 to 2014 was performed. Univariate and multivariate predictors of resection and survival were determined. Results A total of 92 patients (new chemotherapy = 61, old chemotherapy = 31) were analyzed, of which 19 (21%) underwent eventual resection (median overall survival [OS] = 32 vs. 14.3 months for unresected patients, P  = 0.0002). For the overall cohort, resection (hazard ratio [HR] 0.261, P  = 0.014), radiation therapy (HR 0.458, P  = 0.004), number of lines of chemotherapy (HR 0.486, P  = 0.012), and new chemotherapy (HR 0.593 vs. old regimens, P  = 0.065) were independent predictors of OS on multivariate analyses (MVA). On MVA, predictors of eventual resection were head and neck tumors (OR 0.307, P  = 0.033) or SMA involvement (OR 0.285, P  = 0.023). In nonresected patients (73), MVA showed treatment with new chemotherapy (HR 0.452, P  = 0.006), radiation (HR 0.459, P  = 0.006), and number of lines of CT (HR 0.705, P  = 0.013) to be predictors of survival. Conclusions In LAPC, use of FOLFIRNOX and/or gemcitabine/nab-paclitaxel is associated with improved survival compared with older chemotherapy regimens, regardless of eventual resection. Tumor location and relationship to certain vasculature are important determinants of resection in this cohort.