선행항암화학요법 modified FOLFIRINOX 후 수술을 받은 췌관선암 환자에서 보조항암화학요법 시행의 임상적 필요성과 예후

Abstract

Background : The benefit of adjuvant chemotherapy following curative-intent surgery in pancreatic ductal adenocarcinoma (PDAC) patients who had received neoadjuvant modified FOLFIRINOX (mFOLFIRINOX) is unclear. This retrospective analysis aimed to assess the survival benefit of adjuvant chemotherapy in patients in this patient population.

Methods : Between January 2017 and December 2020, 219 patients with localized PDAC who received neoadjuvant mFOLFIRINOX and underwent pancreatectomy were included in this analysis. Survival outcomes were compared according to adjuvant chemotherapy administration and represented as disease-free survival (DFS) and overall survival (OS). Propensity score matching (PSM) was conducted to create balanced cohorts.

Results : Adjuvant chemotherapy was administered to 149 (68.0%) patients. Patients in the adjuvant chemotherapy group received significantly fewer cycles of neoadjuvant chemotherapy (median; 7 vs. 9, p<0.001) compared to the observation group. Patients in the adjuvant chemotherapy group had significantly improved survival compared to the observation group, with a median DFS of 13.4 months (95% CI, 10.7–18.9) vs. 8.3 months (95% CI, 4.9–16.0) (p=0.0039); and a median OS of 33.4 months (95% CI, 29.9–not assessable) vs. 23.8 months (95% CI, 17.9–not assessable) (p=0.0012). In the PSM cohort of 59 matched pairs of patients, the survival benefit of adjuvant chemotherapy remained significant. DFS and OS were significantly better in the adjuvant chemotherapy group regardless of the lymph node status during surgery (p=0.038 for DFS and p=0.016 for OS with positive lymph node; and p=0.028 for DFS and p=0.014 for OS with negative lymph node). In the multivariate analysis, adjuvant chemotherapy was a significant favorable prognostic factor (DFS, hazard ratio [HR] 0.50 (95%CI, 0.34–0.73, p<0.001); OS, HR 0.35 (95%CI, 0.20–0.60, p<0.001).

Conclusion : In PDAC patients who underwent surgery following neoadjuvant mFOLFIRINOX, adjuvant chemotherapy may be associated with improved survival. Its benefit was not affected by the lymph node status.