Introduction:
Pancreatic adenocarcinoma has a poor prognosis with a five-year survival
rate of 9% in 2018 (1). Surgery is the only hope for a cure but only 10% of
patients are diagnosed at a resectable stage (2). Neoadjuvant chemotherapy
folfirinox has been studied as a way to increase resection rate and improve
survival (3).
Objectif:
To evaluate the resection rate after neoadjuvant folfirinox for borderline
resectable and locally advanced pancreatic cancer and to identified prognosis
factors.
Methods:
We retrospectively reviewed patients treated with folfirinox in a neoadjuvant
setting for pancreatic cancer between 2013 and 2019 at a university hospital.
Results:
The resection rate after neoadjuvant folfirinox was 41% with 43% R0
resection. Median survival time (MST) was 26 months overall. MST was not
significantly longer in resected patients (19 months) as compared with nonresected
patients (29 months, P=0.25). There was a tendency towards better
MST for patients who received ≥ 6 cycles of neoadjuvant folfirinox (32
months) as compared to < 6 cycles (19 months, P=0.076). Median
progression free survival (PFS) was 13 months overall. Resected patients
and non-resected patients had similar PFS. Patients with platelet count > 300
x 109/L at diagnosis had a PFS significantly shorter than those with ≤ 300 x
109/L platelet (8 months and 14 months respectively, P=0.01). Leucocytes
count at diagnosis ≥ 8 x 109/L significantly reduced PFS as compared to
leucocytes count < 8 x 109/L (11 months and 14 months respectively,
P=0.04). Furthermore, ≥ 6 cycles of neoadjuvant chemotherapy allowed
patients to survived without progression longer than those with < 6 cycles (8
months versus 14 months, P=0.005). Cox’s proportional hazards regression
univariate analysis showed that platelet count > 300 x 109/L (hazard ratio HR
6.35, P=0.03), leucocytes count ≥ 8 x 109/L (HR 3.3, P=0.06) and < 6 cycles
of neoadjuvant chemotherapy were significantly associated with poor
progression-free survival (HR 4.72, P=0.01). By multivariable analysis, only <
6 cycles of neoadjuvant chemotherapy were independently associated with
poor progression-free survival (HR 6.74, P=0.02).
Conclusion :
In this retrospective analysis, resection rate after neoadjuvant treatment was
41%. High platelet count, high leucocytes count and < 6 cycles of
neoadjuvant treatment seemed to be associated with poor progression-free
survival.