Important Radiologic and Clinical Factors for Predicting Overall Survival in Pancreatic Adenocarcinoma Patients Who Underwent FOLFIRINOX

Abstract

Background To predict poor overall survival (OS) in pancreatic adenocarcinoma (PAC) who underwent FOLFIRINOX (5-fluorouracil/leucovorin/irinotecan/oxaliplatin) using clinical and computed tomography (CT) findings. Methods A total of 189 patients with PAC who received FOLFIRINOX were retrospectively included. Two reviewers assessed CT findings and resectability based on National Comprehensive Cancer Network guidelines. They determined tumor size changes according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1). Delta measurements were performed. Clinical results, such as whether to perform surgery, were also investigated. A Cox proportional hazard model was used to identify significant predictors for OS. A CT-based nomogram was constructed to predict OS. Results Seventy-four patients (39.2%) underwent surgery. For OS, rim enhancement of PAC on baseline CT (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.10–2.77; P = 0.018), high delta tumor on baseline CT (HR, 2.46; 95% CI, 1.55–3.91; P < 0.001), progressive disease at follow-up CT (HR, 8.89; 95% CI, 2.94–26.87; P < 0.001), and without surgery (HR, 2.81; 95% CI, 1.49–5.30; P = 0.001) were important features related to poor prognosis. The nomogram showed good predictive ability for the survival. Conclusion Both clinical and CT findings were useful for predicting OS after FOLFIRINOX in PAC.