Abstract：
BACKGROUND: The efficacy and safety of conversion surgery (CS) after FOLFIRINOX or gemcitabine plus nab-paclitaxel (GnP) chemotherapy in patients with initially unresectable pancreatic cancer (PC) remains unclear.
METHODS: This multicenter retrospective cohort study enrolled patients, between 2014 and 2018, with initially locally advanced or metastatic PC who were considered candidates for CS following FOLFIRINOX or GnP chemotherapy. They were classified into surgery (207 patients [194 resection and 13 exploratory laparotomy only]) and continued chemotherapy (10 patients, control) groups. The primary endpoint was overall survival (OS) from the day of diagnosis of potentially curative resection on imaging studies, with an expected hazard ratio (HR) of 0.7.
RESULTS: OS in the surgery group was longer than that in the control group (HR, 0.47; 95% confidence interval [CI]: 0.24-0.93). The median OS was 34.4 (95% CI: 27.9-43.4) and 19.8 (95% CI: 14.9-31.1) months in the surgery and control groups, respectively. The Clavien-Dindo grade ≥ IIIa postoperative complication and in-hospital mortality rates were 19.6% and 0.5%, respectively. Multivariate analysis revealed that preoperative chemotherapy duration was not associated with OS.
CONCLUSIONS: CS, following a favorable response to FOLFIRINOX or GnP chemotherapy, improved initially unresectable PC prognosis (specifically, OS), regardless of the chemotherapy duration.
METHODS: This multicenter retrospective cohort study enrolled patients, between 2014 and 2018, with initially locally advanced or metastatic PC who were considered candidates for CS following FOLFIRINOX or GnP chemotherapy. They were classified into surgery (207 patients [194 resection and 13 exploratory laparotomy only]) and continued chemotherapy (10 patients, control) groups. The primary endpoint was overall survival (OS) from the day of diagnosis of potentially curative resection on imaging studies, with an expected hazard ratio (HR) of 0.7.
RESULTS: OS in the surgery group was longer than that in the control group (HR, 0.47; 95% confidence interval [CI]: 0.24-0.93). The median OS was 34.4 (95% CI: 27.9-43.4) and 19.8 (95% CI: 14.9-31.1) months in the surgery and control groups, respectively. The Clavien-Dindo grade ≥ IIIa postoperative complication and in-hospital mortality rates were 19.6% and 0.5%, respectively. Multivariate analysis revealed that preoperative chemotherapy duration was not associated with OS.
CONCLUSIONS: CS, following a favorable response to FOLFIRINOX or GnP chemotherapy, improved initially unresectable PC prognosis (specifically, OS), regardless of the chemotherapy duration.
摘要：
背景：FOLFIRINOX或吉西他滨联合nab-紫杉醇（GnP）化疗后的转换手术（CS）对最初无法切除的胰腺癌（PC）患者的疗效和安全性尚不清楚。
方法：这项多中心回顾性队列研究招募了患者，在2014年至2018年期间,最初的局部晚期或转移性PC在FOLFIRINOX或GnP化疗后被认为是CS的候选人.他们被分为手术（207例[仅194例切除和13例剖腹探查术]）和持续化疗（10例，控制)组。主要终点是影像学研究诊断为潜在治愈性切除之日起的总生存期（OS）。预期危险比(HR)为0.7。
结果：手术组的OS长于对照组（HR，0.47；95%置信区间[CI]：0.24-0.93)。手术组和对照组的中位OS分别为34.4(95%CI:27.9-43.4)和19.8(95%CI:14.9-31.1)个月,分别。Clavien-Dindo分级≥IIIa术后并发症和院内死亡率分别为19.6%和0.5%,分别。多因素分析显示术前化疗时间与OS无关。
结论：CS，在对FOLFIRINOX或GnP化疗产生良好反应后，改善了最初不可切除的PC预后(特别是，操作系统),无论化疗持续时间如何。
方法：这项多中心回顾性队列研究招募了患者，在2014年至2018年期间,最初的局部晚期或转移性PC在FOLFIRINOX或GnP化疗后被认为是CS的候选人.他们被分为手术（207例[仅194例切除和13例剖腹探查术]）和持续化疗（10例，控制)组。主要终点是影像学研究诊断为潜在治愈性切除之日起的总生存期（OS）。预期危险比(HR)为0.7。
结果：手术组的OS长于对照组（HR，0.47；95%置信区间[CI]：0.24-0.93)。手术组和对照组的中位OS分别为34.4(95%CI:27.9-43.4)和19.8(95%CI:14.9-31.1)个月,分别。Clavien-Dindo分级≥IIIa术后并发症和院内死亡率分别为19.6%和0.5%,分别。多因素分析显示术前化疗时间与OS无关。
结论：CS，在对FOLFIRINOX或GnP化疗产生良好反应后，改善了最初不可切除的PC预后(特别是，操作系统),无论化疗持续时间如何。
