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Predictors of conversion surgery in patients with pancreatic cancer who underwent neoadjuvant or palliative FOLFIRINOX treatment using baseline and follow-up CT

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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

We aimed to evaluate the predictive factors of conversion surgery in pancreatic adenocarcinoma (PAC) after neoadjuvant or palliative FOLFIRINOX using baseline and follow-up CT.

Methods

We retrospectively included 189 patients who had undergone more than 4 cycles of FOLFIRINOX. We reviewed baseline CT (B-CT), 1st follow-up CT (1st-CT), and the preoperative or last follow-up CT (L-CT) and determined tumor size changes according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1). Extra-pancreatic perineural invasion (EPNI) and resectability using NCCN 2019 guideline were evaluated. Subgroup analysis by baseline resectability was performed.

Results

B-CT included resectable (n = 25, 23.2%), borderline (n = 55, 29.1%), locally advanced (n = 44, 23.3%), and metastatic (n = 65, 34.4%) PAC. Seventy-four patients had undergone surgery (39.2%) with an 83.8% (62/74) R0 resection. For operability, resectable status at L-CT (hazard ratio (HR) 65.5; 95% confidence interval (CI) 5.0–865; P = 0.002), RECIST (partial response) at 1st-CT (HR 3.6; 95% CI 1.1–11.7; P = 0.032), and baseline borderline resectability (HR 8.6; 95% CI 1.6–46.4; P = 0.013) were important predictors. Based on a size reduction cut-off of 22.2%, the area under the receiver operating characteristic (ROC) curve (Az) was 0.761 (sensitivity = 70.3%, specificity = 74.8%). In subgroup analysis, RECIST (partial response) at 1st-CT was a significant predictor of locally advanced PAC (HR 32; 95% CI 4.5–227, P 0.001), and the optimal cut-off was 22.2% (Az = 0.914; sensitivity = 100%, specificity = 75%). Baseline tumor size (\(>\) 4 cm) (HR 5.6, 95% CI 1.3–24.3, P = 0.022) and unresectable status at 1st-CT (HR 4.8, 95% CI 1.1–20.6, P = 0.035) were significantly associated with margin-positive resection.

Conclusion

Both baseline and follow-up CT findings are useful to predict conversion surgery for PAC after FOLFIRINOX.

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Availability of data and materials

We declared that materials described in the manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes, without breaching participant confidentiality.

Code availability

All softwares used during the study appear in the submitted article; No code was generated or used during the study.

Abbreviations

PAC:

Pancreatic adenocarcinoma

FOLFIRINOX:

5-Fluorouracil/leucovorin/irinotecan/oxaliplatin

RECIST:

Response evaluation criteria in solid tumors

EPNI:

Extra-pancreatic perineural invasion

NCCN:

National Comprehensive Cancer Network

ROC:

Receiver operating characteristic

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Sae-Jin Park, Jung Hoon Kim, Ijin Joo & Joon Koo Han

  2. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea

    Sae-Jin Park, Jung Hoon Kim, Ijin Joo & Joon Koo Han

  3. Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jung Hoon Kim & Joon Koo Han

  4. Department of Radiology, SMG-SNU Boramae Medical Cencer, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea

    Sae-Jin Park

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  1. Sae-Jin Park
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Contributions

Conceptualization, Methodology, Supervision, Writing—review & editing: JHK. Methodology, Formal analysis, Writing—original draft: S-JP. Conceptualization, Methodology, Data curation, Investigation, Writing–review: IJ and JKH.

Corresponding author

Correspondence to Jung Hoon Kim.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was approved by Institutional Review Board of Seoul National University Hospital ((IRB No. 2005-122-1124) and written informed consent was waived. This study was in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was waived by Institutional Review Board of Seoul National University Hospital due to retrospective design of the study.

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Park, SJ., Kim, J.H., Joo, I. et al. Predictors of conversion surgery in patients with pancreatic cancer who underwent neoadjuvant or palliative FOLFIRINOX treatment using baseline and follow-up CT. Abdom Radiol 46, 4765–4778 (2021). https://doi.org/10.1007/s00261-021-03127-3

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