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Optimizing Indications for Conversion Surgery Based on Analysis of 454 Consecutive Japanese Cases with Unresectable Pancreatic Cancer Who Received Modified FOLFIRINOX or Gemcitabine Plus Nab-paclitaxel: A Single-Center Retrospective Study

  • Pancreatic Tumors
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The prognosis of initially unresectable pancreatic cancer (UR-PC) has improved since the introduction of FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (GNP) treatment. Nonetheless, the indications and optimal timing for conversion to resection remain unclear for UR-PC. The aim of this study is to evaluate the characteristics of cases with initially UR-PC who received modified FFX or GNP treatment.


This retrospective study reviewed 454 consecutive Japanese UR-PC cases who received modified FFX/GNP treatment. Cases were categorized according to resection status, and overall survival (OS) was evaluated using a multivariable prognostic scoring model (0–4 points, higher score indicating more favorable prognostic factors).


The overall resection rate was 16% for locally advanced UR-PC (UR-LA) and 5% for metastatic UR-PC (UR-M). The resection group had better OS than the nonresection group (median OS time: not reached versus 13.0 months, P < 0.001). The independent prognostic factors were normalized CA19-9 concentration, modified Glasgow prognostic score of 0, tumor shrinkage after chemotherapy, chemotherapy duration ≥ 8 months, and resection. Cases were grouped according to their prognostic score, and the results suggested that candidates for resection might have prognostic scores of 4 points in UR-M cases or 2–4 points in UR-LA cases.


Stratification according to prognostic score was useful in predicting the outcomes of UR-PC cases and may aid in identifying cases who might benefit from surgical treatment after responding to chemotherapy.

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The authors thank Mamiko Miyashita, MD, and Tomotaka Kato, MD, for helpful discussions and organization of the patient data. The authors thank Naoki Ishizuka, PhD, and Nozomi Kurihara, PhD, Department of Clinical Trial Planning and Management, Cancer Institute Hospital, for valuable indications in statistical analysis.

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Correspondence to Yosuke Inoue MD, PhD.

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Masato Ozaka received honoraria from Taiho Pharmaceutical Co., Ltd. and Yakult Honsha Co., Ltd. Takashi Sasaki received honoraria from Taiho Pharmaceutical Co., Ltd. and Yakult Honsha Co., Ltd. Naoki Sasahira received honoraria from Taiho Pharmaceutical Co., Ltd. The remaining authors declare no conflicts of interest. No funding was received for this study.

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Ushida, Y., Inoue, Y., Oba, A. et al. Optimizing Indications for Conversion Surgery Based on Analysis of 454 Consecutive Japanese Cases with Unresectable Pancreatic Cancer Who Received Modified FOLFIRINOX or Gemcitabine Plus Nab-paclitaxel: A Single-Center Retrospective Study. Ann Surg Oncol 29, 5038–5050 (2022).

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