Poor prognostic factors in long-term survivors of resected pancreatic ductal adenocarcinoma: An international, multicenter cohort study
Document Type
Article
Department
Medical College Pakistan
Abstract
Objective: To measure the rate of LTS in resected PDAC and determine the association between predictors of OS and LTS.
Summary background data: Long-term survival (>5 y, LTS) remains rare in pancreatic ductal adenocarcinoma (PDAC). Multiple predictors of overall survival (OS) are known but their association with LTS remains unclear.
Methods: An international, multicenter retrospective study was conducted. Included were patients from 2012-2019 with resected PDAC. Excluded were those with metastases at diagnosis or resection, R2 resections, and 90-day mortality. Predictors of OS were identified using multivariable Cox regression and their prevalence in patients with LTS assessed. LTS was calculated by excluding patients with shorter follow-up and predictors of LTS were identified using multivariable logistic regression.
Results: 3,003 patients were included (27.4% received neoadjuvant chemotherapy). Elevated baseline CA19-9, high tumor grade, nodal disease, and perineural and lymphovascular invasion were negative independent predictors of OS, while receipt of adjuvant chemotherapy predicted improved OS (all P<0.05). LTS was observed in 220/2,436 patients (9.0%), of whom 198 (90%) harbored poor prognostic factors: elevated baseline CA19-9 (58.1%), poor tumor differentiation (51.0%), nodal disease (46.8%), and perineural invasion (76.0%). Of those without any of these four features, 50.0% achieved LTS as compared to 21.3%, 13.3%, 5.2%, and 3.5% in those with 1, 2, 3, or 4 features.
Conclusions: This bi-national cohort demonstrates a true LTS rate of 9.0% in resected PDAC. Clinicians should remain aware that presence of poor prognostic factors does not preclude LTS.
Publication (Name of Journal)
Annals of Surgery
DOI
doi.org/10.1097/sla.0000000000006539
Recommended Citation
Javed, A. A.,
Rompen, I. F.,
Mahmud, O.,
Fatimi, A. S.,
van Goor, I. W.,
Andel, P.,
Stoop, T. F.,
Habib, J. R.,
Mughal, N. A.,
Lafaro, K.,
Burkhar, R. A.,
Burns, W. R.,
Schouten, T.,
Santvoort, H. C.,
Dulk, M. d.
(2024). Poor prognostic factors in long-term survivors of resected pancreatic ductal adenocarcinoma: An international, multicenter cohort study. Annals of Surgery.
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_mc/476
Comments
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