The Relationship between Treatment Response and Overall Survival in Borderline, Non-Resectable and Resectable Pancreatic Cancer Patients Treated with Neoadjuvant FOLFIRINOX
Abstract
:1. Introduction
2. Methods
2.1. Patient Population
2.2. Initial Evaluation
2.3. Chemotherapy and Response Evaluation
2.4. Surgery
2.5. Pathologic Characteristics
2.6. Follow-Up
2.7. Statistical Analysis
3. Results
3.1. Treatment
3.2. Response to Treatment
3.2.1. Radiologic Response
3.2.2. Clinical and Biochemical Response
3.2.3. Pathological Response
3.3. Postoperative Course
3.4. Survival
Predictors of Survival
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Siegel, R.L.; Miller, K.D.; Fuchs, H.E.; Jemal, A. Cancer statistics, 2022. CA Cancer J. Clin. 2022, 72, 7–33. [Google Scholar] [CrossRef] [PubMed]
- Strobel, O.; Lorenz, P.; Hinz, U.; Gaida, M.; König, A.-K.; Hank, T.; Niesen, W.; Kaiser, J.Ö.R.; Al-Saeedi, M.; Bergmann, F.; et al. Actual Five-year Survival After Upfront Resection for Pancreatic Ductal Adenocarcinoma: Who Beats the Odds? Ann. Surg. 2022, 275, 962–971. [Google Scholar] [CrossRef]
- Rahib, L.; Wehner, M.R.; Matrisian, L.M.; Nead, K.T. Estimated Projection of US Cancer Incidence and Death to 2040. JAMA Netw. Open 2021, 4, e214708. [Google Scholar] [CrossRef] [PubMed]
- Conroy, T.; Hammel, P.; Hebbar, M.; Ben Abdelghani, M.; Wei, A.C.; Raoul, J.-L.; Choné, L.; Francois, E.; Artru, P.; Biagi, J.J.; et al. FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer. N. Engl. J. Med. 2018, 379, 2395–2406. [Google Scholar] [CrossRef] [PubMed]
- Guidelines Detail. Available online: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455 (accessed on 21 August 2024).
- Casadei, R.; Di Marco, M.; Ricci, C.; Santini, D.; Serra, C.; Calculli, L.; D’Ambra, M.; Guido, A.; Morselli-Labate, A.M.; Minni, F. Neoadjuvant Chemoradiotherapy and Surgery Versus Surgery Alone in Resectable Pancreatic Cancer: A Single-Center Prospective, Randomized, Controlled Trial Which Failed to Achieve Accrual Targets. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract 2015, 19, 1802–1812. [Google Scholar] [CrossRef] [PubMed]
- Birrer, D.L.; Golcher, H.; Casadei, R.; Haile, S.R.; Fritsch, R.; Hussung, S.; Brunner, T.B.; Fietkau, R.; Meyer, T.; Grützmann, R.; et al. Neoadjuvant Therapy for Resectable Pancreatic Cancer: A New Standard of Care. Pooled Data from 3 Randomized Controlled Trials. Ann. Surg. 2021, 274, 713–720. [Google Scholar] [CrossRef]
- Golcher, H.; Brunner, T.B.; Witzigmann, H.; Marti, L.; Bechstein, W.-O.; Bruns, C.; Jungnickel, H.; Schreiber, S.; Grabenbauer, G.G.; Meyer, T.; et al. Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer: Results of the first prospective randomized phase II trial. Strahlenther. Onkol. Organ Dtsch. Rontgenges. Al 2015, 191, 7–16. [Google Scholar] [CrossRef] [PubMed]
- Michelakos, T.; Pergolini, I.; Castillo, C.F.-D.; Honselmann, K.C.; Cai, L.; Deshpande, V.; Wo, J.Y.; Ryan, D.P.; Allen, J.N.; Blaszkowsky, L.S.; et al. Predictors of Resectability and Survival in Patients with Borderline and Locally Advanced Pancreatic Cancer who Underwent Neoadjuvant Treatment with FOLFIRINOX. Ann. Surg. 2019, 269, 733–740. [Google Scholar] [CrossRef]
- Bolton, N.M.; Maerz, A.H.; Brown, R.E.; Bansal, M.; Bolton, J.S.; Conway, W.C. Multiagent neoadjuvant chemotherapy and tumor response are associated with improved survival in pancreatic cancer. HPB 2019, 21, 413–418. [Google Scholar] [CrossRef]
- Kim, R.Y.; Christians, K.K.; Aldakkak, M.; Clarke, C.N.; George, B.; Kamgar, M.; Khan, A.H.; Kulkarni, N.; Hall, W.A.; Erickson, B.A.; et al. Total Neoadjuvant Therapy for Operable Pancreatic Cancer. Ann. Surg. Oncol. 2021, 28, 2246–2256. [Google Scholar] [CrossRef]
- Murphy, J.E.; Wo, J.Y.; Ryan, D.P.; Jiang, W.; Yeap, B.Y.; Drapek, L.C.; Blaszkowsky, L.S.; Kwak, E.L.; Allen, J.N.; Clark, J.W.; et al. Total Neoadjuvant Therapy with FOLFIRINOX Followed by Individualized Chemoradiotherapy for Borderline Resectable Pancreatic Adenocarcinoma: A Phase 2 Clinical Trial. JAMA Oncol. 2018, 4, 963–969. [Google Scholar] [CrossRef] [PubMed]
- Versteijne, E.; Suker, M.; Groothuis, K.; Akkermans-Vogelaar, J.M.; Besselink, M.G.; Bonsing, B.A.; Buijsen, J.; Busch, O.R.; Creemers, G.-J.M.; van Dam, R.M.; et al. Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2020, 38, 1763–1773. [Google Scholar] [CrossRef]
- Truty, M.J.; Kendrick, M.L.; Nagorney, D.M.; Smoot, R.L.; Cleary, S.P.; Graham, R.P.; Goenka, A.H.; Hallemeier, C.L.; Haddock, M.G.; Harmsen, W.S.; et al. Factors Predicting Response, Perioperative Outcomes, and Survival Following Total Neoadjuvant Therapy for Borderline/Locally Advanced Pancreatic Cancer. Ann. Surg. 2021, 273, 341–349. [Google Scholar] [CrossRef] [PubMed]
- Cloyd, J.M.; Wang, H.; Egger, M.E.; Tzeng, C.-W.D.; Prakash, L.R.; Maitra, A.; Varadhachary, G.R.; Shroff, R.; Javle, M.; Fogelman, D.; et al. Association of Clinical Factors with a Major Pathologic Response Following Preoperative Therapy for Pancreatic Ductal Adenocarcinoma. JAMA Surg. 2017, 152, 1048–1056. [Google Scholar] [CrossRef]
- Ahmad, S.A.; Duong, M.; Sohal, D.P.S.; Gandhi, N.S.; Beg, M.S.; Wang-Gillam, A.; Wade, J.L.; Chiorean, E.G.; Guthrie, K.A.; Lowy, A.M.; et al. Surgical Outcome Results from SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma. Ann. Surg. 2020, 272, 481–486. [Google Scholar] [CrossRef]
- Heger, U.; Sun, H.; Hinz, U.; Klaiber, U.; Tanaka, M.; Liu, B.; Sachsenmaier, M.; Springfeld, C.; Michalski, C.W.; Büchler, M.W.; et al. Induction chemotherapy in pancreatic cancer: CA 19-9 may predict resectability and survival. HPB 2020, 22, 224–232. [Google Scholar] [CrossRef]
- Perri, G.; Prakash, L.; Qiao, W.; Varadhachary, G.R.; Wolff, R.; Fogelman, D.; Overman, M.; Pant, S.; Javle, M.; Koay, E.J.; et al. Response and Survival Associated with First-line FOLFIRINOX vs Gemcitabine and nab-Paclitaxel Chemotherapy for Localized Pancreatic Ductal Adenocarcinoma. JAMA Surg. 2020, 155, 832. [Google Scholar] [CrossRef]
- Leonhardt, C.-S.; Pils, D.; Qadan, M.; Jomrich, G.; Assawasirisin, C.; Klaiber, U.; Sahora, K.; Warshaw, A.L.; Ferrone, C.R.; Schindl, M.; et al. The Revised R Status is an Independent Predictor of Postresection Survival in Pancreatic Cancer after Neoadjuvant Treatment. Ann. Surg. 2023. publish ahead of print. [Google Scholar] [CrossRef]
- Klaiber, U.; Schnaidt, E.S.; Hinz, U.; Gaida, M.M.; Heger, U.; Hank, T.; Strobel, O.; Neoptolemos, J.P.; Mihaljevic, A.L.; Büchler, M.W.; et al. Prognostic Factors of Survival after Neoadjuvant Treatment and Resection for Initially Unresectable Pancreatic Cancer. Ann. Surg. 2021, 273, 154–162. [Google Scholar] [CrossRef]
- Conroy, T.; Desseigne, F.; Ychou, M.; Bouché, O.; Guimbaud, R.; Bécouarn, Y.; Adenis, A.; Raoul, J.-L.; Gourgou-Bourgade, S.; de la Fouchardière, C.; et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N. Engl. J. Med. 2011, 364, 1817–1825. [Google Scholar] [CrossRef] [PubMed]
- Eisenhauer, E.A.; Therasse, P.; Bogaerts, J.; Schwartz, L.H.; Sargent, D.; Ford, R.; Dancey, J.; Arbuck, S.; Gwyther, S.; Mooney, M.; et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur. J. Cancer Oxf. Engl. 1990 2009, 45, 228–247. [Google Scholar] [CrossRef] [PubMed]
- Lee, S.M.; Katz, M.H.G.; Liu, L.; Sundar, M.; Wang, H.; Varadhachary, G.R.; Wolff, R.A.; Lee, J.E.; Maitra, A.; Fleming, J.B.; et al. Validation of a Proposed Tumor Regression Grading Scheme for Pancreatic Ductal Adenocarcinoma after Neoadjuvant Therapy as a Prognostic Indicator for Survival. Am. J. Surg. Pathol. 2016, 40, 1653–1660. [Google Scholar] [CrossRef]
- Verbeke, C.S.; Menon, K.V. Redefining resection margin status in pancreatic cancer. HPB 2009, 11, 282–289. [Google Scholar] [CrossRef] [PubMed]
- Katz, M.H.G.; Shi, Q.; Meyers, J.; Herman, J.M.; Chuong, M.; Wolpin, B.M.; Ahmad, S.; Marsh, R.; Schwartz, L.; Behr, S.; et al. Efficacy of Preoperative mFOLFIRINOX vs mFOLFIRINOX Plus Hypofractionated Radiotherapy for Borderline Resectable Adenocarcinoma of the Pancreas: The A021501 Phase 2 Randomized Clinical Trial. JAMA Oncol. 2022, 8, 1263–1270. [Google Scholar] [CrossRef] [PubMed]
- Versteijne, E.; van Dam, J.L.; Suker, M.; Janssen, Q.P.; Groothuis, K.; Akkermans-Vogelaar, J.M.; Besselink, M.G.; Bonsing, B.A.; Buijsen, J.; Busch, O.R.; et al. Neoadjuvant Chemoradiotherapy Versus Upfront Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Long-Term Results of the Dutch Randomized PREOPANC Trial. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2022, 40, 1220–1230. [Google Scholar] [CrossRef]
- Ghaneh, P.; Palmer, D.; Cicconi, S.; Jackson, R.; Halloran, C.M.; Rawcliffe, C.; Sripadam, R.; Mukherjee, S.; Soonawalla, Z.; Wadsley, J.; et al. Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX, or chemoradiotherapy in patients with borderline resectable pancreatic cancer (ESPAC5): A four-arm, multicentre, randomised, phase 2 trial. Lancet Gastroenterol. Hepatol. 2023, 8, 157–168. [Google Scholar] [CrossRef] [PubMed]
- Alliance for Clinical Trials in Oncology A Phase III Trial of Perioperative Versus Adjuvant Chemotherapy for Resectable Pancreatic Cancer. Clinicaltrials.Gov; 2023. Available online: https://clinicaltrials.gov/study/NCT04340141 (accessed on 1 January 2023).
- Mesopancreas Study in Pancreatic Cancer—Full Text View—ClinicalTrials.Gov. Available online: https://classic.clinicaltrials.gov/ct2/show/NCT05895214 (accessed on 13 December 2023).
- Ferrone, C.R.; Marchegiani, G.; Hong, T.S.; Ryan, D.P.; Deshpande, V.; McDonnell, E.I.; Sabbatino, F.; Santos, D.D.; Allen, J.N.; Blaszkowsky, L.S.; et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann. Surg. 2015, 261, 12–17. [Google Scholar] [CrossRef] [PubMed]
- Katz, M.H.G.; Fleming, J.B.; Bhosale, P.; Varadhachary, G.; Lee, J.E.; Wolff, R.; Wang, H.; Abbruzzese, J.; Pisters, P.W.T.; Vauthey, J.-N.; et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 2012, 118, 5749–5756. [Google Scholar] [CrossRef]
- Yasuta, S.; Kobayashi, T.; Aizawa, H.; Takahashi, S.; Ikeda, M.; Konishi, M.; Kojima, M.; Kuno, H.; Uesaka, K.; Morinaga, S.; et al. Relationship between surgical R0 resectability and findings of peripancreatic vascular invasion on CT imaging after neoadjuvant S-1 and concurrent radiotherapy in patients with borderline resectable pancreatic cancer. BMC Cancer 2020, 20, 1184. [Google Scholar] [CrossRef]
- Balaban, D.V.; Marin, F.S.; Manucu, G.; Zoican, A.; Ciochina, M.; Mina, V.; Patoni, C.; Vladut, C.; Bucurica, S.; Costache, R.S.; et al. Clinical characteristics and outcomes in carbohydrate antigen 19-9 negative pancreatic cancer. World J. Clin. Oncol. 2022, 13, 630. [Google Scholar] [CrossRef]
- Lee, W.; Park, Y.; Kwon, J.W.; Jun, E.; Song, K.B.; Lee, J.H.; Hwang, D.W.; Yoo, C.; Kim, K.-P.; Jeong, J.H.; et al. Reduced and Normalized Carbohydrate Antigen 19-9 Concentrations after Neoadjuvant Chemotherapy Have Comparable Prognostic Performance in Patients with Borderline Resectable and Locally Advanced Pancreatic Cancer. J. Clin. Med. 2020, 9, 1477. [Google Scholar] [CrossRef]
- Mellon, E.A.; Jin, W.H.; Frakes, J.M.; Centeno, B.A.; Strom, T.J.; Springett, G.M.; Malafa, M.P.; Shridhar, R.; Hodul, P.J.; Hoffe, S.E. Predictors and survival for pathologic tumor response grade in borderline resectable and locally advanced pancreatic cancer treated with induction chemotherapy and neoadjuvant stereotactic body radiotherapy. Acta Oncol. Stockh. Swed. 2017, 56, 391–397. [Google Scholar] [CrossRef] [PubMed]
- Al Abbas, A.I.; Zenati, M.; Reiser, C.J.; Hamad, A.; Jung, J.P.; Zureikat, A.H.; Zeh, H.J.; Hogg, M.E. Serum CA19-9 Response to Neoadjuvant Therapy Predicts Tumor Size Reduction and Survival in Pancreatic Adenocarcinoma. Ann. Surg. Oncol. 2020, 27, 2007–2014. [Google Scholar] [CrossRef] [PubMed]
- van Veldhuisen, E.; Vogel, J.A.; Klompmaker, S.; Busch, O.R.; van Laarhoven, H.W.M.; van Lienden, K.P.; Wilmink, J.W.; Marsman, H.A.; Besselink, M.G. Added value of CA19-9 response in predicting resectability of locally advanced pancreatic cancer following induction chemotherapy. HPB 2018, 20, 605–611. [Google Scholar] [CrossRef] [PubMed]
- Maman, Y.; Goykhman, Y.; Yakir, O.; Barenboim, A.; Geva, R.; Peles-Avraham, S.; Wolf, I.; Klausner, J.M.; Lahat, G.; Lubezky, N. Adjuvant FOLFIRINOX in Patients with Resectable Pancreatic Cancer Is Effective but Rarely Feasible in Real Life: Is Neoadjuvant FOLFIRINOX a Better Option? Cancers 2023, 15, 3049. [Google Scholar] [CrossRef]
- Amin, M.B.; Greene, F.L.; Edge, S.B.; Compton, C.C.; Gershenwald, J.E.; Brookland, R.K.; Meyer, L.; Gress, D.M.; Byrd, D.R.; Winchester, D.P. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J. Clin. 2017, 67, 93–99. [Google Scholar] [CrossRef]
Variable | Number |
---|---|
(70 Patients) | |
Median age at diagnosis, years (range) | 64 (44–79) |
Males | 45 (64.3%) |
Tumor location | |
Head/uncinate (right of SMV) | 47 (67.1%) |
Body/tail (left of SMV) | 23 (32.9%) |
Median neoadjuvant FOLFIRINOX cycles | 6 (3–16) |
Median length of NAT (days) | 75 (28–296) |
Adjuvant FOLFIRINOX | |
Yes | 30 (42.8%) |
No | 36 (51.5%) |
Unknown | 4 (5.7%) |
Median total FOLFIRINOX courses (neoadjuvant + adjuvant) | 8 (3–16) |
Radiation before surgery | |
Yes | 7 (10%) |
No | 63 (90%) |
Operation | |
Radical pancreaticoduodenectomy | 42 (60%) |
Distal pancreatectomy | 22 (31.4%) |
Total pancreatectomy | 6 (8.6%) |
Venous resection | |
Yes | 32 (45.7%) |
No | 38 (54.3%) |
Arterial resection | |
Yes | 10 (14.3%) |
No | 60 (85.7%) |
Median length of stay (days) | 10 (4–52) |
Reoperation | 4 (5.7%) |
Postoperative complications with CD > 2 | 9 (12.8%) |
(a) | ||
Variable | Number (70 Patients) | |
Radiological downstaging by resectability | ||
Yes | 11 (15.7%) | |
No | 52 (74.3%) | |
Upstaging | 3 (4.3%) | |
Missing | 4 (5.7%) | |
RECIST classification | ||
CR + NCR | 6 (8.6%) | |
PR | 30 (42.9%) | |
SD | 28 (40%) | |
PD | 4 (5.7%) | |
Missing | 2 (2.8%) | |
Median percentage of diameter decrease in tumor | 25 (0–100) | |
(b) | ||
Before Treatment | After Treatment | |
Resectability based on NCCN criteria | ||
Resectable | 8 (11.4%) | 14 (20%) |
Borderline | 48 (68.6%) | 44 (62.9%) |
Unresectable | 10 (14.3%) | 8 (11.4) |
Missing | 4 (5.7%) | 4 (5.7%) |
Median imaging diameter of tumor (mm) | 35 (0–81) | 25 (0–58) |
Artery involvement at imaging | ||
Yes | 24 (34.3%) | 22 (31.4%) |
No | 33 (47.1%) | 39 (55.7%) |
Missing | 13 (18.6) | 9 (12.8%) |
Vein involvement at imaging | ||
Yes | 37 (52.8%) | 24 (34.4%) |
No | 20 (28.6%) | 37 (52.8%) |
Missing | 13 (18.6%) | 9 (12.8%) |
Variable | Number |
---|---|
(70 Patients) | |
CA 19-9 level before neoadjuvant FOLFIRINOX | |
Normal | 20 (28.6%) |
Increased | 47 (67.2%) |
Missing | 3 (4.2%) |
CA 19-9 level after neoadjuvant FOLFIRINOX | |
Normal | 36 (51.4%) |
Increased | 30 (42.8%) |
Missing | 4 (5.8%) |
Number of patients after chemotherapy whose CA 19-9: | |
Decreased | 39 (55.8%) |
Increased | 10 (14.3%) |
Remained normal | 16 (22.8%) |
Missing | 5 (7.1%) |
Median CA 19-9 at disease onset (U/L) | 105 (80–6989) |
Median CA 19-9 after treatment (U/L) | 35 (2–1981) |
Median percentage of decrease of elevated CA 19-9 (U/L) | 80.9 (1–99.6) |
Variable | Number |
---|---|
(70 Patients) | |
Type of tumor | |
Adenocarcinoma | 58 (82.9%) |
Acinic carcinoma | 1 (1.4%) |
0 (complete response) | 9 (12.9%) |
Missing | 2 (2.8%) |
Median size of tumor (cm) | 2 (0–4) |
Median total lymph nodes | 14.5 (1–21) |
Positive lymph nodes | |
Yes | 25 (35.7%) |
No | 35 (64.3%) |
Grade | |
0 | 9 (12.8%) |
Well-differentiated | 10 (14.2%) |
Moderately differentiated | 31 (44.2%) |
Poorly differentiated | 15 (21.4%) |
Missing | 5 (7.4%) |
Perineural invasion | |
No | 44 (62.8%) |
Yes | 22 (31.5%) |
Missing | 4 (5.7%) |
Lymphovascular invasion | |
Yes | 13 (18.6%) |
No | 52 (74.3%) |
Missing | 5 (7.1%) |
Radial margins involvement | |
Yes | 10 (14.3%) |
No | 57 (81.5%) |
Missing | 3 (4.2%) |
TRG (CAP) | |
0 | 9 (12.9%) |
1 | 4 (5.7%) |
2 | 30 (42.9%) |
3 | 22 (31.4%) |
Missing | 5 (7.1%) |
(a) | ||||||||
Variable | B | SE | Wald | Df | Sig. | Exp(B) | 95.0% CI for Exp(B) | |
Lower | Upper | |||||||
Age above 65 years | 0.05 | 0.02 | 5.25 | 1 | 0.02 | 1.05 | 1.007 | 1.09 |
Nonresectable after NAT | 1.98 | 0.64 | 9.43 | 1 | 0.002 | 7.2 | 2.04 | 25.4 |
Re-operation | 2.06 | 0.70 | 8.59 | 1 | 0.003 | 7.8 | 1.9 | 31.07 |
Lymph nodes involved by tumor or TRG 2 and 3 | 1.47 | 0.76 | 3.71 | 1 | 0.05 | 4.3 | 0.9 | 19.2 |
Artery involvement at imaging before treatment | 1.09 | 0.49 | 5.03 | 1 | 0.02 | 2.9 | 1.1 | 7.7 |
(b) | ||||||||
Variable | B | SE | Wald | Df | Sig. | Exp(B) | 95.0% CI for Exp(B) | |
Lower | Upper | |||||||
Age above 65 years and number of chemotherapy cycles below nine | 1.44 | 0.53 | 7.26 | 1 | 0.007 | 4.2 | 1.4 | 12.03 |
Nonresectable after NAT | 1.95 | 0.66 | 8.72 | 1 | 0.003 | 7.04 | 1.9 | 25.7 |
Re-operation | 1.42 | 0.72 | 3.92 | 1 | 0.047 | 4.1 | 1.01 | 16.8 |
Lymph nodes involved by tumor | 1.92 | 0.49 | 15.42 | 1 | 0.0001 | 6.8 | 2.6 | 17.7 |
Artery involvement at imaging before treatment | 1.09 | 0.49 | 5.03 | 1 | 0.02 | 2.9 | 1.1 | 7.7 |
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Barenboim, A.; Mercer, D.; Sahnan, K.; Gaffan, A.; Goren, O.; Halperin, S.; Brazowski, E.; Pelles Avraham, S.; Klausner, J.M.; Lubezky, N. The Relationship between Treatment Response and Overall Survival in Borderline, Non-Resectable and Resectable Pancreatic Cancer Patients Treated with Neoadjuvant FOLFIRINOX. J. Clin. Med. 2024, 13, 5206. https://doi.org/10.3390/jcm13175206
Barenboim A, Mercer D, Sahnan K, Gaffan A, Goren O, Halperin S, Brazowski E, Pelles Avraham S, Klausner JM, Lubezky N. The Relationship between Treatment Response and Overall Survival in Borderline, Non-Resectable and Resectable Pancreatic Cancer Patients Treated with Neoadjuvant FOLFIRINOX. Journal of Clinical Medicine. 2024; 13(17):5206. https://doi.org/10.3390/jcm13175206
Chicago/Turabian StyleBarenboim, Alex, Diego Mercer, Kapil Sahnan, Alex Gaffan, Or Goren, Sharon Halperin, Eli Brazowski, Sharon Pelles Avraham, Joseph M. Klausner, and Nir Lubezky. 2024. "The Relationship between Treatment Response and Overall Survival in Borderline, Non-Resectable and Resectable Pancreatic Cancer Patients Treated with Neoadjuvant FOLFIRINOX" Journal of Clinical Medicine 13, no. 17: 5206. https://doi.org/10.3390/jcm13175206