Restaging after neoadjuvant FOLFIRINOX for localized pancreatic cancer: a clinical calculator from the Trans-Atlantic...

Restaging after neoadjuvant chemotherapy aims to assess treatment response, revise prognosis, and guide further management. This study investigated independent prognostic factors for overall survival after restaging in patients with localized pancreatic adenocarcinoma.

In this retrospective international study, consecutive patients with localized pancreatic adenocarcinoma who received at least 1 cycle of (m)FOLFIRINOX as first-line therapy were identified. Multivariable Cox regression analysis was performed with a web-based calculator to predict individualized overall survival.

The Trans-Atlantic Pancreatic Surgery cohort included 2338 patients with localized pancreatic adenocarcinoma of whom 22.6% were potentially resectable, 30.7% borderline resectable, and 46.7% locally advanced at initial staging. Several baseline characteristics remained independent prognostic factors for overall survival after restaging: borderline resectable (hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.14 to 1.51), locally advanced (HR = 1.78, 95% CI = 1.55 to 2.05), body or tail tumor (HR = 0.79, 95% CI = 0.68 to 0.90), and baseline World Health Organization performance status of 1 (HR = 1.18, 95% CI = 1.07 to 1.30) or at least 2 (HR = 1.54, 95% CI = 1.20 to 1.98). Additional independent factors were metastatic disease at restaging (HR = 1.57, 95% CI = 1.31 to 1.87), postinduction carbohydrate antigen 19-9 (HR = 1.47, 95% CI = 1.37 to 1.57), Δcarbohydrate antigen 19-9 (HR = 0.83, 95% CI = 0.77 to 0.89), postinduction tumor size (HR = 1.22, 95% CI = 1.11 to 1.35), and Δtumor size (HR = 0.92, 95% CI = 0.87 to 0.98). Patients were stratified into 4 risk groups, with 3-year overall survival after restaging ranging from 6.0% to 65.8%.

Survival at restaging after neoadjuvant chemotherapy of patients with localized pancreatic adenocarcinoma is determined by 8 patient, tumor, and treatment response characteristics. A web-based calculator can inform clinicians and patients about individualized prognosis and guide further management.