{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T01:46:54Z","timestamp":1794534414834,"version":"4.9.1"},"reference-count":63,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:sec id=\"ab-coi240076-4\"><jats:title>Importance<\/jats:title><jats:p>The effect of adjuvant chemotherapy following resection of pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX (combination leucovorin calcium [folinic acid], fluorouracil, irinotecan hydrochloride, and oxaliplatin in full or modified dosing) chemotherapy on overall survival (OS) is unclear because current studies do not account for the number of cycles of preoperative chemotherapy and adjuvant chemotherapy regimen.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240076-5\"><jats:title>Objective<\/jats:title><jats:p>To investigate the association of adjuvant chemotherapy following resection of pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX with OS, taking into account the number of cycles of preoperative chemotherapy and adjuvant chemotherapy regimen.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240076-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective cohort study included patients with localized pancreatic adenocarcinoma treated with 2 to 11 cycles of preoperative (m)FOLFIRINOX followed by resection across 48 centers in 20 countries from 2010 to 2018. Patients who died within 3 months after surgery were excluded (landmark). Data were analyzed from February 1 to December 31, 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240076-7\"><jats:title>Exposures<\/jats:title><jats:p>Preoperative (m)FOLFIRINOX chemotherapy followed by resection and eventually followed by adjuvant chemotherapy.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240076-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was OS, calculated from the 3-month landmark. Cox regression analysis, including interaction analyses, was performed to investigate the association of adjuvant chemotherapy with OS.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240076-9\"><jats:title>Results<\/jats:title><jats:p>Overall, 767 patients were included after resection of pancreatic adenocarcinoma (median [IQR] age, 62 [55-67] years; 404 [52.7%] male). Adjuvant chemotherapy was independently associated with prolonged OS (hazard ratio [HR], 0.66; 95% CI, 0.49-0.87), confirmed by adjusted OS curves. The interaction analysis to assess estimated treatment effect across subgroups was not statistically significant. The forest plot and interaction test suggest that the association of adjuvant chemotherapy was lower among patients receiving 8 or more cycles of preoperative (m)FOLFIRINOX, those who had radiological response, and those with ypN0 disease. Compared to no adjuvant chemotherapy, both adjuvant (m)FOLFIRINOX (HR, 0.57; 95% CI, 0.40-0.80) and other multiagent adjuvant regimens (HR, 0.61; 95% CI, 0.41-0.92) were associated with prolonged OS, whereas single-agent adjuvant chemotherapy was not (HR, 0.75; 95% CI, 0.55-1.03).<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240076-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cohort study, adjuvant (m)FOLFIRINOX and other multiagent chemotherapy regimens were associated with improved OS following resection of localized pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX, whereas single-agent adjuvant chemotherapy was not. The impact of adjuvant chemotherapy on OS may be lower in subgroups such as patients with 8 or more preoperative cycles of (m)FOLFIRINOX, those having radiological response, and those with ypN0.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2024.5917","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T16:32:19Z","timestamp":1737649939000},"page":"276","source":"Crossref","is-referenced-by-count":23,"title":["Adjuvant Chemotherapy After Resection of Localized Pancreatic Adenocarcinoma Following Preoperative FOLFIRINOX"],"prefix":"10.1001","volume":"11","author":[{"given":"Thomas F.","family":"Stoop","sequence":"first","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora"},{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshitaka","family":"Sugawara","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora"},{"name":"Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Oba","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora"},{"name":"Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan"},{"name":"Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel M.","family":"Feld","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stijn","family":"van Roessel","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eran","family":"van Veldhuisen","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y. 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Andrew","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora"},{"name":"Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"},{"name":"The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Nishino","sequence":"additional","affiliation":[{"name":"Division of Bioinformatics, Research Institute National Cancer Center Japan, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahsoem","family":"Ali","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Alseidi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Virginia Mason Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Sauvanet","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery and Liver Transplantation, H\u00f4pital Beaujon, University Paris Cit\u00e9, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonello","family":"Mirabella","sequence":"additional","affiliation":[{"name":"General Surgery Department, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Sa Cunha","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Surgery, Liver Transplant Center, Universit\u00e9 Paris-Sud, Universit\u00e9 Paris-Saclay, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arto","family":"Kokkola","sequence":"additional","affiliation":[{"name":"Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"Groot Koerkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Pietrasz","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Surgery, Liver Transplant Center, Universit\u00e9 Paris-Sud, Universit\u00e9 Paris-Saclay, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyre","family":"Kleive","sequence":"additional","affiliation":[{"name":"Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Butturini","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pederzoli Hospital, Peschiera, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Malleo","sequence":"additional","affiliation":[{"name":"Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke W. 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