Prediction of resection after preoperative FOLFIRINOX in patients with localized pancreatic adenocarcinoma: a Trans-Atlantic Pancreatic Surgery (TAPS) Consortium study.

backgroundNeoadjuvant chemotherapy is increasingly used for patients with localized pancreatic ductal adenocarcinoma (PDAC), although the likelihood of subsequent resection remains uncertain. The aim of this study was to develop a prediction model using baseline characteristics to estimate the probability of meeting prespecified criteria for resection after induction FOLFIRINOX.

methodsThis retrospective study included patients with localized PDAC who received (m)FOLFIRINOX as initial treatment in 5 referral centers in the United States and the Netherlands (2012-2019). Multivariable logistic regression identified independent predictors of resection and was used to develop a prediction model.

resultsAmong 1835 patients, 18.9% were classified as potentially resectable (PR), 28.9% as borderline resectable (BR), and 52.2% as locally advanced (LA). Observed resection rates were 70.5% for PR, 53.1% for BR, and 17.8% for LA PDAC. Unfavorable independent factors for resection were advanced anatomical stage (BR, OR = 0.51; 95% CI = 0.37 to 0.69 and LA, OR = 0.11; 95% CI = 0.08 to 0.15), baseline CA19-9 >500 U/mL (OR = 0.60; 95% CI = 0.46 to 0.77), a WHO performance status of ≥1 (OR = 0.41; 95% CI = 0.33 to 0.52), and tumor size on baseline imaging >40 mm (OR = 0.62; 95% CI = 0.48 to 0.80). Depending on these factors, the predicted probability of resection ranged from 6.7% to 81.7%.

conclusionAt diagnosis, the probability of resection after induction (m)FOLFIRINOX for localized PDAC ranged from 7% to 82%, depending on anatomical stage, CA19-9 level, performance status, and tumor size at baseline. This prediction model may help communicate realistic expectations for the probability of resection.