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

Abstract

Restaging after neoadjuvant chemotherapy aims to assess treatment response, revise prognosis, and guide further management. This study investigated independent prognostic factors for overall survival (OS) after restaging in patients with localized pancreatic adenocarcinoma (PDAC). In this retrospective international study, consecutive patients with localized PDAC who received at least one cycle of (m)FOLFIRINOX as first-line therapy were identified. Multivariable Cox regression analysis was performed with a web-based calculator to predict individualized OS. The TAPS cohort included 2338 patients with localized PDAC, 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 OS after restaging borderline resectable (HR 1.31 [95% CI 1.14-1.51]), locally advanced (HR 1.78 [95% CI 1.55-2.05]), body/tail tumor (HR 0.79 [95% CI 0.68-0.90]), and baseline WHO performance status of 1 (HR 1.18 [95% CI 1.07-1.30]) or ≥ 2 (HR 1.54 [95% CI 1.20-1.98]). Additional independent factors were metastatic disease at restaging (HR 1.57 [95% CI 1.31-1.87]), post-induction CA19-9 (HR 1.47 [95% CI 1.37-1.57]), ΔCA19-9 (HR 0.83 [95% CI 0.77-0.89]), post-induction tumor size (HR 1.22 [95% CI 1.11-1.35]), and Δtumor size (HR 0.92 [95% CI 0.87-0.98]). Patients were stratified into four risk groups, with 3-year OS after restaging ranging from 6.0% to 65.8%. Survival at restaging after neoadjuvant chemotherapy of patients with localized PDAC is determined by eight patient, tumor and treatment response characteristics. A web-based calculator can inform clinicians and patients about individualized prognosis and guide further management.