TY - JOUR
T1 - Poor Prognostic Factors in Long-Term Survivors of Resected Pancreatic Ductal Adenocarcinoma
T2 - An International, Multicenter Cohort Study
AU - Javed, Ammar A
AU - Rompen, Ingmar F
AU - van Goor, Iris W J M
AU - Stoop, Thomas F
AU - Andel, Paul
AU - Mahmud, Omar
AU - Fatimi, Asad Saulat
AU - Habib, Joseph R
AU - Mughal, Nabiha A
AU - Schouten, Thijs
AU - Lafaro, Kelly
AU - Burkhart, Richard A
AU - Burns, William R
AU - Santvoort, Hjalmar C van
AU - Dulk, Marcel den
AU - Daams, Freek
AU - Mieog, J Sven D
AU - Stommel, Martijn W J
AU - Patijn, Gijs A
AU - Hingh, Ignace de
AU - Festen, Sebastiaan
AU - Nijkamp, Maarten W
AU - Klaase, Joost M
AU - Lips, Daan J
AU - Wijsman, Jan H
AU - Harst, Erwin van der
AU - Manusama, Eric
AU - Eijck, Casper H J van
AU - Koerkamp, Bas Groot
AU - Kazemier, Geert
AU - Busch, Olivier R
AU - Molenaar, I Quintus
AU - Daamen, Lois A
AU - He, Jin
AU - Wolfgang, Christopher L
AU - Besselink, Marc G
AU - Dutch Pancreatic Cancer Group
AU - PANC-PALS Consortium
PY - 2024/9/17
Y1 - 2024/9/17
N2 - 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 years, 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.
AB - 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 years, 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.
U2 - 10.1097/SLA.0000000000006539
DO - 10.1097/SLA.0000000000006539
M3 - Article
SN - 0003-4932
JO - Annals of Surgery
JF - Annals of Surgery
ER -