Influence of a biliary stent in patients with advanced pancreatic cancer treated with modified FOLFIRINOX

Abstract Purpose We aimed to elucidate the effects of biliary stents on the survival in patients with advanced pancreatic cancer treated with modified FOLFIRINOX (mFFX). Methods We retrospectively reviewed the medical charts of patients with advanced pancreatic cancer treated with mFFX between January 2014 and April 2020. In the analysis, we compared the overall survival (OS) of patients with and those without biliary stent during the mFFX treatment, and examined the independent effect on mortality by means of propensity score-matching. Results Overall, we included 89 patients (stent group, n = 24; non-stent group, n = 65). The proportion of patients with pancreatic head cancer was significantly higher in the stent group than in the non-stent group (p < 0.01). Stratification analysis in patients with pancreatic head cancer revealed that OS was significantly shorter in the stent group than in the non-stent group (p = 0.03). After propensity score-matching, 19 pairs of patients in each group were analyzed. The stent group revealed a significantly shorter survival than the non-stent group (median OS, 10.3 vs. 24.9 months, respectively; p < 0.01). The incidences of febrile neutropenia (p = 0.01) and biliary tract-related events (p < 0.01) were significantly higher in the stent group than in the non-stent group. Stent insertion was an independent risk factor for overall mortality. Conclusions Biliary stents may reduce survival in patients with advanced pancreatic cancer. Although they are essential for treating malignant biliary obstruction and for safe chemotherapy, we need to assess the patient’s condition with discretion and develop a treatment strategy with the short prognosis in mind after stent insertion.