A matched survival analysis of patients treated with neoadjuvant FOLFIRINOX prior to pancreatic surgery: prognosis changes with downstaging of disease

Abstract

Background: There is a paucity of data relating to the oncological behaviour of pancreatic tumours following neoadjuvant FOLFIRINOX. Methods: Patients with pancreatic adenocarcinoma who received neoadjuvant FOLFIRINOX chemotherapy (FOLFIRINOX group) in a single centre were matched by age, sex, type of surgery, performance status and post-operative histological stage with a group who did not receive neoadjuvant therapy prior to pancreatic surgery (MATCH group). Statistical methods included Kaplan-Meier survival estimates with log-rank test and Cox proportional hazard regression. Co-variates included: age, sex, performance status, type of surgery, PV resection, Ca19-9, presentation & pre-op radiological stage, histological stage, tumour differentiation, lymphovascular or perineural invasion, and neoadjuvant radiation therapy. Results: Fourteen patients in the FOLFIRINOX group (median age 60; 8F) were identified from a prospectively managed database and were matched 1:1 using described criteria. Mean overall survival for FOLFIRINOX and MATCH were 37.4 (95% CI 20.3 -54.4) and 40.8 (95% CI 29.4 - 52.2) months respectively (p=0.459). There was no difference in disease free survival (22.2. v 29.8; p=0.259). Cox regression analysis identified only margin status (p=0.008) as a prognostic indicator for overall survival. Conclusion: In this series prognosis following neoadjuvant FOLFIRINOX appears similar to the stage of disease achieved following treatment rather than at presentation.