No codified/systematic surveillance program exists for borderline/locally advanced pancreatic ductal carcinoma treated with neoadjuvant FOLFIRINOX and a secondary resection. This study aimed to determine the trend of recurrence in patients who were managed using such a treatment strategy. From 2010, 101 patients received FOLFIRINOX and underwent a pancreatectomy, in a minimum follow-up of 5 years. Seventy-one patients (70%, R group) were diagnosed with recurrence after a median follow-up of 11 months postsurgery. In the multivariable analysis, patients in the R-group had a higher rate of weight loss (p= 0.018), higher carbohydrate antigen (CA 19-9) serum levels at diagnosis (p= 0.012), T3/T4 stage (p= 0.017), and positive lymph nodes (p< 0.01) compared to patients who did not experience recurrence. The risk of recurrence in patients with T1/T2 N0 R0 was the lowest (19%), and all recurrences occurred during the first two postoperative years. The peak risk of recurrence for the entire population was observed during the first two postoperative years. The probability of survival decreased until the second year and rebounded to 100% permanently, after the ninth postoperative year. Close monitoring is needed at reduced intervals during the first 2 years following a pancreatectomy and should be extended to later than 5 years for those with unfavorable pathological results.
目前，对于接受新辅助FOLFIRINOX化疗后进行二次切除的临界/局部晚期胰腺导管癌，尚无系统化的监测方案。本研究旨在确定采用该治疗策略患者的复发趋势。自2010年起，共有101例患者接受FOLFIRINOX化疗并接受胰腺切除术，术后随访至少5年。其中71例患者（70%，R组）在中位术后11个月被诊断为复发。多变量分析显示，与未复发患者相比，R组患者在诊断时体重下降率更高（p=0.018）、碳水化合物抗原（CA 19-9）血清水平更高（p=0.012）、T3/T4分期比例更高（p=0.017）且淋巴结阳性率更高（p<0.01）。T1/T2 N0 R0患者的复发风险最低（19%），所有复发均发生在术后前两年内。整体人群的复发风险高峰出现在术后前两年。生存概率在术后第二年持续下降，而在术后第九年后永久回升至100%。建议在胰腺切除术后前2年缩短监测间隔进行密切随访，对于病理结果不良的患者，监测期应延长至5年以上。
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