Comparing short- and long-term survivors in metastatic pancreatic cancer: Insights into patient and disease profiles impacting systemic therapy outcomes

Aim The study aims to identify prognostic pre-treatment characteristics in patients with metastatic pancreatic adenocarcinoma (mPAC) initiating systemic therapy stratified for short- and long-term survival, to support personalised treatment and improve palliative care outcomes. Methods This retrospective nationwide study included patients diagnosed with synchronous mPAC and registered in the Netherlands Cancer Registry, 2015–2022, who received palliative systemic therapy. Patient, tumour and treatment characteristics were compared between short-term survivors (STS) (survival '90 days since diagnosis) and long-term survivors (LTS) (survival '365 days since diagnosis). A multivariate analysis was conducted to assess the independent prognostic value of various characteristics on short- and long-term survival outcomes. Results Among 2862 patients with mPAC, 18 % were LTS and 30 % STS. LTS showed better pre-treatment performance status, fewer cardiovascular comorbidities, smaller tumours, lower CA19–9 levels, and more frequently normal albumin and LDH levels. Lung-only metastases occurred more frequently in LTS, while multiple sites predominated in STS. LTS were more often treated with FOLFIRINOX (82 % vs. 61 %). Multivariable analysis showed that older age, poor performance, cardiovascular disease, hypalbuminaemia, elevated LDH and bilirubin levels were prognostic factors indicating worse survival, while diabetes, lower CA19–9 levels, and lung-only metastases favoured longer survival. Conclusion Patient- and tumour-specific characteristics strongly influence survival in mPAC patients receiving systemic therapy. These findings can support a more detailed risk stratification at diagnosis to optimise treatment selection, avoid both over- and undertreatment, and align care with individual patient expectations and values for more personalised treatment strategies.