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28.11.2016 | Pancreatic Tumors | Ausgabe 5/2017

Annals of Surgical Oncology 5/2017

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

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 5/2017
Autoren:
MD, PhD Filip Bednar, MD, MPH, PhD Mazen S. Zenati, BS Jennifer Steve, MS Sharon Winters, MD Lee M. Ocuin, MD, PhD Nathan Bahary, MD Melissa E. Hogg, MD Herbert J. Zeh III, MD Amer H. Zureikat

Abstract

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.

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Zusatzmaterial
Supplementary material 1 (DOCX 281 kb)
10434_2016_5707_MOESM1_ESM.docx
Literatur
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