Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis

Lilly J H Brada; Lois A Daamen; Lisa G Magermans; Marieke S Walma; Diba Latifi; Ronald M van Dam; Ignace H de Hingh; Mike S L Liem; Vincent E de Meijer; Gijs A Patijn; Sebastiaan Festen; Martijn W J Stommel; Koop Bosscha; Marco B Polée; Yung C Nio; Frank J Wessels; Jan J J de Vries; Krijn P van Lienden; Rutger C Bruijnen; Olivier R Busch; Bas Groot Koerkamp; Casper van Eijck; Quintus I Molenaar; Hanneke J W Wilmink; Hjalmar C van Santvoort; Marc G Besselink; Dutch Pancreatic Cancer Group

doi:10.1097/SLA.0000000000005120

Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis

Lilly J H Brada^*, Lois A Daamen, Lisa G Magermans, Marieke S Walma, Diba Latifi, Ronald M van Dam, Ignace H de Hingh, Mike S L Liem, Vincent E de Meijer, Gijs A Patijn, Sebastiaan Festen, Martijn W J Stommel, Koop Bosscha, Marco B Polée, Yung C Nio, Frank J Wessels, Jan J J de Vries, Krijn P van Lienden, Rutger C Bruijnen, Olivier R BuschBas Groot Koerkamp, Casper van Eijck, Quintus I Molenaar, Hanneke J W Wilmink, Hjalmar C van Santvoort, Marc G Besselink^*, Dutch Pancreatic Cancer Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: This study compared median OS after resection of LAPC after upfront FOLFIRINOX versus a propensity-score matched cohort of LAPC patients treated with FOLFIRINOX-only (ie, without resection).

BACKGROUND: Because the introduction of FOLFIRINOX chemotherapy, increased resection rates in LAPC patients have been reported, with improved OS. Some studies have also reported promising OS with FOLFIRINOX-only treatment in LAPC. Multicenter studies assessing the survival benefit associated with resection of LAPC versus patients treated with FOLFIRINOX-only are lacking.

METHODS: Patients with non-progressive LAPC after 4 cycles of FOLFIRINOX treatment, both with and without resection, were included from a prospective multicenter cohort in 16 centers (April 2015-December 2019). Cox regression analysis identified predictors for OS. One-to-one propensity score matching (PSM) was used to obtain a matched cohort of patients with and without resection. These patients were compared for OS.

RESULTS: Overall, 293 patients with LAPC were included, of whom 89 underwent a resection. Resection was associated with improved OS (24 vs 15 months, P < 0.01), as compared to patients without resection. Before PSM, resection, Charlson Comorbidity Index, and Response Evaluation Criteria in Solid Tumors (RECIST) response were predictors for OS. After PSM, resection remained associated with improved OS [Hazard Ratio (HR) 0.344, 95% confidence interval (0.222-0.534), P < 0.01], with an OS of 24 versus 15 months, as compared to patients without resection. Resection of LAPC was associated with improved 3-year OS (31% vs 11%, P < 0.01).

CONCLUSIONS: Resection of LAPC after FOLFIRINOX was associated with increased OS and 3-year survival, as compared to propensity-score matched patients treated with FOLFIRINOX-only.

Original language	English
Pages (from-to)	729-735
Number of pages	7
Journal	Annals of Surgery
Volume	274
Issue number	5
DOIs	https://doi.org/10.1097/SLA.0000000000005120
Publication status	Published - 1 Nov 2021

Keywords

Antineoplastic Agents/therapeutic use
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Female
Fluorouracil/therapeutic use
Follow-Up Studies
Humans
Irinotecan/therapeutic use
Leucovorin/therapeutic use
Male
Middle Aged
Neoplasm Staging
Netherlands/epidemiology
Oxaliplatin/therapeutic use
Pancreas/pathology
Pancreatectomy/methods
Pancreatic Neoplasms/diagnosis
Propensity Score
Prospective Studies
Survival Rate/trends
SURGERY
FOLFIRINOX
locally advanced pancreatic cancer
QUALITY-OF-LIFE
BORDERLINE
ADENOCARCINOMA
NEOADJUVANT THERAPY
resection
IMPACT
OUTCOMES

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10.1097/SLA.0000000000005120

Cite this

Brada, L. J. H., Daamen, L. A., Magermans, L. G., Walma, M. S., Latifi, D., van Dam, R. M., de Hingh, I. H., Liem, M. S. L., de Meijer, V. E., Patijn, G. A., Festen, S., Stommel, M. W. J., Bosscha, K., Polée, M. B., Nio, Y. C., Wessels, F. J., de Vries, J. J. J., van Lienden, K. P., Bruijnen, R. C., ... Dutch Pancreatic Cancer Group (2021). Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis. Annals of Surgery, 274(5), 729-735. https://doi.org/10.1097/SLA.0000000000005120

@article{f6b8a1197f0f45d2a47a8a2519257410,

title = "Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis",

abstract = "OBJECTIVE: This study compared median OS after resection of LAPC after upfront FOLFIRINOX versus a propensity-score matched cohort of LAPC patients treated with FOLFIRINOX-only (ie, without resection).BACKGROUND: Because the introduction of FOLFIRINOX chemotherapy, increased resection rates in LAPC patients have been reported, with improved OS. Some studies have also reported promising OS with FOLFIRINOX-only treatment in LAPC. Multicenter studies assessing the survival benefit associated with resection of LAPC versus patients treated with FOLFIRINOX-only are lacking.METHODS: Patients with non-progressive LAPC after 4 cycles of FOLFIRINOX treatment, both with and without resection, were included from a prospective multicenter cohort in 16 centers (April 2015-December 2019). Cox regression analysis identified predictors for OS. One-to-one propensity score matching (PSM) was used to obtain a matched cohort of patients with and without resection. These patients were compared for OS.RESULTS: Overall, 293 patients with LAPC were included, of whom 89 underwent a resection. Resection was associated with improved OS (24 vs 15 months, P < 0.01), as compared to patients without resection. Before PSM, resection, Charlson Comorbidity Index, and Response Evaluation Criteria in Solid Tumors (RECIST) response were predictors for OS. After PSM, resection remained associated with improved OS [Hazard Ratio (HR) 0.344, 95% confidence interval (0.222-0.534), P < 0.01], with an OS of 24 versus 15 months, as compared to patients without resection. Resection of LAPC was associated with improved 3-year OS (31% vs 11%, P < 0.01).CONCLUSIONS: Resection of LAPC after FOLFIRINOX was associated with increased OS and 3-year survival, as compared to propensity-score matched patients treated with FOLFIRINOX-only.",

keywords = "Antineoplastic Agents/therapeutic use, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Female, Fluorouracil/therapeutic use, Follow-Up Studies, Humans, Irinotecan/therapeutic use, Leucovorin/therapeutic use, Male, Middle Aged, Neoplasm Staging, Netherlands/epidemiology, Oxaliplatin/therapeutic use, Pancreas/pathology, Pancreatectomy/methods, Pancreatic Neoplasms/diagnosis, Propensity Score, Prospective Studies, Survival Rate/trends, SURGERY, FOLFIRINOX, locally advanced pancreatic cancer, QUALITY-OF-LIFE, BORDERLINE, ADENOCARCINOMA, NEOADJUVANT THERAPY, resection, IMPACT, OUTCOMES",

author = "Brada, {Lilly J H} and Daamen, {Lois A} and Magermans, {Lisa G} and Walma, {Marieke S} and Diba Latifi and {van Dam}, {Ronald M} and {de Hingh}, {Ignace H} and Liem, {Mike S L} and {de Meijer}, {Vincent E} and Patijn, {Gijs A} and Sebastiaan Festen and Stommel, {Martijn W J} and Koop Bosscha and Pol{\'e}e, {Marco B} and Nio, {Yung C} and Wessels, {Frank J} and {de Vries}, {Jan J J} and {van Lienden}, {Krijn P} and Bruijnen, {Rutger C} and Busch, {Olivier R} and Koerkamp, {Bas Groot} and {van Eijck}, Casper and Molenaar, {Quintus I} and Wilmink, {Hanneke J W} and {van Santvoort}, {Hjalmar C} and Besselink, {Marc G} and {Dutch Pancreatic Cancer Group}",

year = "2021",

month = nov,

day = "1",

doi = "10.1097/SLA.0000000000005120",

language = "English",

volume = "274",

pages = "729--735",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "5",

}

Brada, LJH, Daamen, LA, Magermans, LG, Walma, MS, Latifi, D, van Dam, RM , de Hingh, IH, Liem, MSL, de Meijer, VE, Patijn, GA, Festen, S, Stommel, MWJ, Bosscha, K, Polée, MB, Nio, YC, Wessels, FJ, de Vries, JJJ, van Lienden, KP, Bruijnen, RC, Busch, OR, Koerkamp, BG, van Eijck, C, Molenaar, QI, Wilmink, HJW, van Santvoort, HC, Besselink, MG & Dutch Pancreatic Cancer Group 2021, 'Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis', Annals of Surgery, vol. 274, no. 5, pp. 729-735. https://doi.org/10.1097/SLA.0000000000005120

Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis. / Brada, Lilly J H; Daamen, Lois A; Magermans, Lisa G et al.
In: Annals of Surgery, Vol. 274, No. 5, 01.11.2021, p. 729-735.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only

T2 - Multicenter Propensity Score-matched Analysis

AU - Brada, Lilly J H

AU - Daamen, Lois A

AU - Magermans, Lisa G

AU - Walma, Marieke S

AU - Latifi, Diba

AU - van Dam, Ronald M

AU - de Hingh, Ignace H

AU - Liem, Mike S L

AU - de Meijer, Vincent E

AU - Patijn, Gijs A

AU - Festen, Sebastiaan

AU - Stommel, Martijn W J

AU - Bosscha, Koop

AU - Polée, Marco B

AU - Nio, Yung C

AU - Wessels, Frank J

AU - de Vries, Jan J J

AU - van Lienden, Krijn P

AU - Bruijnen, Rutger C

AU - Busch, Olivier R

AU - Koerkamp, Bas Groot

AU - van Eijck, Casper

AU - Molenaar, Quintus I

AU - Wilmink, Hanneke J W

AU - van Santvoort, Hjalmar C

AU - Besselink, Marc G

AU - Dutch Pancreatic Cancer Group

PY - 2021/11/1

Y1 - 2021/11/1

N2 - OBJECTIVE: This study compared median OS after resection of LAPC after upfront FOLFIRINOX versus a propensity-score matched cohort of LAPC patients treated with FOLFIRINOX-only (ie, without resection).BACKGROUND: Because the introduction of FOLFIRINOX chemotherapy, increased resection rates in LAPC patients have been reported, with improved OS. Some studies have also reported promising OS with FOLFIRINOX-only treatment in LAPC. Multicenter studies assessing the survival benefit associated with resection of LAPC versus patients treated with FOLFIRINOX-only are lacking.METHODS: Patients with non-progressive LAPC after 4 cycles of FOLFIRINOX treatment, both with and without resection, were included from a prospective multicenter cohort in 16 centers (April 2015-December 2019). Cox regression analysis identified predictors for OS. One-to-one propensity score matching (PSM) was used to obtain a matched cohort of patients with and without resection. These patients were compared for OS.RESULTS: Overall, 293 patients with LAPC were included, of whom 89 underwent a resection. Resection was associated with improved OS (24 vs 15 months, P < 0.01), as compared to patients without resection. Before PSM, resection, Charlson Comorbidity Index, and Response Evaluation Criteria in Solid Tumors (RECIST) response were predictors for OS. After PSM, resection remained associated with improved OS [Hazard Ratio (HR) 0.344, 95% confidence interval (0.222-0.534), P < 0.01], with an OS of 24 versus 15 months, as compared to patients without resection. Resection of LAPC was associated with improved 3-year OS (31% vs 11%, P < 0.01).CONCLUSIONS: Resection of LAPC after FOLFIRINOX was associated with increased OS and 3-year survival, as compared to propensity-score matched patients treated with FOLFIRINOX-only.

AB - OBJECTIVE: This study compared median OS after resection of LAPC after upfront FOLFIRINOX versus a propensity-score matched cohort of LAPC patients treated with FOLFIRINOX-only (ie, without resection).BACKGROUND: Because the introduction of FOLFIRINOX chemotherapy, increased resection rates in LAPC patients have been reported, with improved OS. Some studies have also reported promising OS with FOLFIRINOX-only treatment in LAPC. Multicenter studies assessing the survival benefit associated with resection of LAPC versus patients treated with FOLFIRINOX-only are lacking.METHODS: Patients with non-progressive LAPC after 4 cycles of FOLFIRINOX treatment, both with and without resection, were included from a prospective multicenter cohort in 16 centers (April 2015-December 2019). Cox regression analysis identified predictors for OS. One-to-one propensity score matching (PSM) was used to obtain a matched cohort of patients with and without resection. These patients were compared for OS.RESULTS: Overall, 293 patients with LAPC were included, of whom 89 underwent a resection. Resection was associated with improved OS (24 vs 15 months, P < 0.01), as compared to patients without resection. Before PSM, resection, Charlson Comorbidity Index, and Response Evaluation Criteria in Solid Tumors (RECIST) response were predictors for OS. After PSM, resection remained associated with improved OS [Hazard Ratio (HR) 0.344, 95% confidence interval (0.222-0.534), P < 0.01], with an OS of 24 versus 15 months, as compared to patients without resection. Resection of LAPC was associated with improved 3-year OS (31% vs 11%, P < 0.01).CONCLUSIONS: Resection of LAPC after FOLFIRINOX was associated with increased OS and 3-year survival, as compared to propensity-score matched patients treated with FOLFIRINOX-only.

KW - Antineoplastic Agents/therapeutic use

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Female

KW - Fluorouracil/therapeutic use

KW - Follow-Up Studies

KW - Humans

KW - Irinotecan/therapeutic use

KW - Leucovorin/therapeutic use

KW - Male

KW - Middle Aged

KW - Neoplasm Staging

KW - Netherlands/epidemiology

KW - Oxaliplatin/therapeutic use

KW - Pancreas/pathology

KW - Pancreatectomy/methods

KW - Pancreatic Neoplasms/diagnosis

KW - Propensity Score

KW - Prospective Studies

KW - Survival Rate/trends

KW - SURGERY

KW - FOLFIRINOX

KW - locally advanced pancreatic cancer

KW - QUALITY-OF-LIFE

KW - BORDERLINE

KW - ADENOCARCINOMA

KW - NEOADJUVANT THERAPY

KW - resection

KW - IMPACT

KW - OUTCOMES

U2 - 10.1097/SLA.0000000000005120

DO - 10.1097/SLA.0000000000005120

M3 - Article

C2 - 34334641

SN - 0003-4932

VL - 274

SP - 729

EP - 735

JO - Annals of Surgery

JF - Annals of Surgery

IS - 5

ER -