Improved Clinical Staging System for Localized Pancreatic Cancer Using the ABC Factors: A TAPS Consortium Study
-
Published:2024-02-05
Issue:
Volume:
Page:
-
ISSN:0732-183X
-
Container-title:Journal of Clinical Oncology
-
language:en
-
Short-container-title:JCO
Author:
Dekker Esther N.1ORCID, van Dam Jacob L.1ORCID, Janssen Quisette P.1, Besselink Marc G.23ORCID, DeSilva Annissa4, Doppenberg Deesje23, van Eijck Casper H.J.1ORCID, Nasar Naaz5, O'Reilly Eileen M.6ORCID, Paniccia Alessandro4, Prakash Laura R.7ORCID, Tzeng Ching-Wei D.7ORCID, Verkolf Eva M.M.1, Wei Alice C.5ORCID, Zureikat Amer H.4, Katz Matthew H.G.7, Groot Koerkamp Bas1ORCID, Asmar Rudy el, Haviland Dana, Ilagan Crisanta, McIntyre Caitlin, McIntyre Sarah, Stoop Thomas F., Theijse Rutger T.,
Affiliation:
1. Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands 2. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands 3. Cancer Center Amsterdam, Amsterdam, the Netherlands 4. Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 5. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 6. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 7. Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
Abstract
PURPOSE Previous studies suggest that besides anatomy (A: resectable, borderline resectable [BR], or locally advanced [LA]) also biologic (B: carbohydrate antigen 19-9 [CA 19-9]) and conditional (C: performance status) factors should be considered when staging patients with localized pancreatic ductal adenocarcinoma (PDAC). The prognostic value of the combined ABC factors has not been quantitatively validated. METHODS In this retrospective cohort study, we evaluated patients with localized PDAC treated with initial (modified) fluorouracil with leucovorin, irinotecan, and oxaliplatin ([m]FOLFIRINOX) at five high-volume pancreatic cancer centers in the United States and the Netherlands (2012-2019). Multivariable Cox proportional hazards analysis was used to investigate the impact of the ABC factors for overall survival (OS). RESULTS Overall, 1,835 patients with localized PDAC were included. Tumor stage at diagnosis was potentially resectable in 346 (18.9%), BR in 531 (28.9%), and LA in 958 (52.2%) patients. The baseline CA 19-9 was >500 U/mL in 559 patients (32.5%). Performance status was ≥1 in 1,110 patients (60.7%). Independent poor prognostic factors for OS were BR disease (hazard ratio [HR], 1.26 [95% CI, 1.06 to 1.50]), LA disease (HR, 1.71 [95% CI, 1.45 to 2.02]), CA 19-9 >500 U/mL (HR, 1.36 [95% CI, 1.21 to 1.52]), and WHO performance status ≥1 (HR, 1.31 [95% CI, 1.16 to 1.47]). Patients were assigned 1 point for each poor ABC factor and 2 points for LA disease. The median OS for patients with score 0-4 was 49.7, 29.9, 22.0, 19.1, and 14.9 months with corresponding 5-year OS rates of 47.0%, 28.9%, 19.2%, 9.3%, and 4.8%, respectively. CONCLUSION The ABC factors of tumor anatomy, CA 19-9, and performance status at diagnosis were independent prognostic factors for OS in patients with localized PDAC treated with initial (m)FOLFIRINOX. Staging of patients with localized PDAC at diagnosis should be based on anatomy, CA 19-9, and performance status.
Publisher
American Society of Clinical Oncology (ASCO)
Subject
Cancer Research,Oncology
|
|