FOLFIRINOX为基础的新辅助化疗后局部进展期胰腺癌的手术疗效分析

Analysis of surgical efficacy for locally advanced pancreatic cancer following FOLFIRINOX-based neoadjuvant treatment

目的:探讨局部进展期胰腺癌(LAPC)患者行FOLFIRINOX(5-氟尿嘧啶、奥沙利铂、伊立替康、亚叶酸钙)为基础的新辅助化疗后的手术切除率及临床结局。方法:计算机检索多个国内外数据库,收集LAPC患者行FOLFIRINOX为基础的新辅助化疗后手术治疗的临床研究,检索时限均为从建库至2016年1月。采用STATA12.0对纳入的研究行Meta分析。结果:共纳入14项临床研究,714例LAPC患者。Meta分析结果显示,术前接受FOLFIRINOX为基础治疗的LAPC患者手术切除率为59%(95%CI=0.46~0.72,P=0.0001),其中R0切除率为70.0%(95%CI=0.51~0.88,P=0.001);同时患者中位生存期为20.63个月(95%CI=16.54~24.73,P=0.001),中位无疾病进展期为13.54个月(95%CI=10.54~16.54,P=0.0001);不良反应发生率为8%(95%CI=0.05~0.11,P=0.0001)。结论:FOLFIRINOX为基础的新辅助化疗可提高LAPC手术切除率,增加R_0切除机会,改善患者生存期,且不良反应发生率较低,是LAPC降期治疗的较优方案。

Objective： To evaluate the surgical resection rates and clinical outcomes in patients with locally advanced pancreatic cancer （LAPC） after neoadjuvant treatment based on FOLFIRINOX regimen （5-fluorouracil, oxaliplatin, irinotecan, and leucovorin）. Methods： The clinical studies regarding LAPC undergoing surgical resection after FOLFIRINOX-based treatment were collected by searching several national and international online databases. The retrieval time was from inception of the database to January 2016. Meta-analysis was performed on the enrolled studies by using STATA 12.0 software. Results： Fourteen studies involving 714 LAPC patients were included. Results of Meta-analysis showed that in LAPC patients receiving FOLFIRINOX-based treatment prior to surgical resection, the resection rate was 59% （95% CI=0.46-0.72, P=0.O001） in which the Ro rate was 70.0% （95% CI=0.51-0.88, P=0.O01）; the median overall survival was 20.63 months （95% CI=16.54-24.73, P=0.001） and median progression-free survival was 13.54 months （95% CI= 10.54-16.54, P=O.O001）; the incidence of adverse reactions was 8% （95% CI=0.05-0.11, P=O.O001）. Conclusion： For LAPC, FOLFIRINOX-based neoadiuvant treatment can increase the resection rates and opportunity of R0 resection, and improve the overall survival of the patients, with low incidence of adverse reactions. So it is recommended as a preferred regimen.