Lilly J H Brada1,2, Marieke S Walma1,2, Lois A Daamen1, Stijn van Roessel2, Ronald M van Dam3, Ignace H de Hingh4,5, Mike L S Liem6, Vincent E de Meijer7, Gijs A Patijn8, Sebastiaan Festen9, Martijn W J Stommel10, Koop Bosscha11, Marco B Polée12, C Yung Nio13, Frank J Wessels14, Jan J J de Vries15, Krijn P van Lienden14, Rutger C Bruijnen14, Maartje Los16, Nadia Haj Mohammad16, Hanneke W Wilmink17, Olivier R Busch2, Marc G Besselink2, I Quintus Molenaar1, Hjalmar C van Santvoort1. 1. Department of Surgery, UMC Utrecht Cancer Center, St Antonius Hospital Nieuwegein and Meander Medical Center, Utrecht, The Netherlands. 2. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Surgery, Maastricht UMC+, Maastricht, The Netherlands. 4. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. 5. Department of Epidemiology, Maastricht University, Maastricht, The Netherlands. 6. Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands. 7. Department of Surgery, UMC Groningen, Groningen, The Netherlands. 8. Department of Surgery, Isala, Zwolle, The Netherlands. 9. Department of Surgery, OLVG, Amsterdam, The Netherlands. 10. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. 11. Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. 12. Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, The Netherlands. 13. Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 14. Department of Radiology, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht University, Utrecht, The Netherlands. 15. Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, VU University, Amsterdam, The Netherlands. 16. Department of Medical Oncology, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands. 17. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND AND OBJECTIVES: Patients with locally advanced pancreatic cancer (LAPC) are increasingly treated with FOLFIRINOX, resulting in improved survival and resection of tumors that were initially unresectable. It remains unclear, however, which specific patients benefit from FOLFIRINOX. Two nomograms were developed predicting overall survival (OS) and resection at the start of FOLFIRINOX for LAPC. METHODS: From our multicenter, prospective LAPC registry in 14 Dutch hospitals, LAPC patients starting first-line FOLFIRINOX (April 2015-December 2017) were included. Stepwise backward selection according to the Akaike Information Criterion was used to identify independent baseline predictors for OS and resection. Two prognostic nomograms were generated. RESULTS: A total of 252 patients were included, with a median OS of 14 months. Thirty-two patients (13%) underwent resection, with a median OS of 23 months. Older age, female sex, Charlson Comorbidity Index ≤1, and CA 19.9 < 274 were independent factors predicting a better OS (c-index: 0.61). WHO ps >1, involvement of the superior mesenteric artery, celiac trunk, and superior mesenteric vein ≥ 270° were independent factors decreasing the probability of resection (c-index: 0.79). CONCLUSIONS: Two nomograms were developed to predict OS and resection in patients with LAPC before starting treatment with FOLFIRINOX. These nomograms could be beneficial in the shared decision-making process and counseling of these patients.
BACKGROUND AND OBJECTIVES:Patients with locally advanced pancreatic cancer (LAPC) are increasingly treated with FOLFIRINOX, resulting in improved survival and resection of tumors that were initially unresectable. It remains unclear, however, which specific patients benefit from FOLFIRINOX. Two nomograms were developed predicting overall survival (OS) and resection at the start of FOLFIRINOX for LAPC. METHODS: From our multicenter, prospective LAPC registry in 14 Dutch hospitals, LAPC patients starting first-line FOLFIRINOX (April 2015-December 2017) were included. Stepwise backward selection according to the Akaike Information Criterion was used to identify independent baseline predictors for OS and resection. Two prognostic nomograms were generated. RESULTS: A total of 252 patients were included, with a median OS of 14 months. Thirty-two patients (13%) underwent resection, with a median OS of 23 months. Older age, female sex, Charlson Comorbidity Index ≤1, and CA 19.9 < 274 were independent factors predicting a better OS (c-index: 0.61). WHO ps >1, involvement of the superior mesenteric artery, celiac trunk, and superior mesenteric vein ≥ 270° were independent factors decreasing the probability of resection (c-index: 0.79). CONCLUSIONS: Two nomograms were developed to predict OS and resection in patients with LAPC before starting treatment with FOLFIRINOX. These nomograms could be beneficial in the shared decision-making process and counseling of these patients.
Authors: Guus Grimbergen; Hidde Eijkelenkamp; Hanne D Heerkens; Bas W Raaymakers; Martijn P W Intven; Gert J Meijer Journal: Phys Imaging Radiat Oncol Date: 2021-12-21