Actual Five-year Survival After Upfront Resection for Pancreatic Ductal Adenocarcinoma: Who Beats the Odds?

Abstract

OBJECTIVE:

To determine actual five-year survival (5YS) rates associated with a strategy of upfront surgery and adjuvant therapy in pancreatic ductal adenocarcinoma (PDAC).

BACKGROUND:

The rate of actual 5YS in PDAC remains controversial. Available data is restricted to cohorts acquired over several decades and series of resection after patient selection by neoadjuvant therapy.

METHODS:

All patients undergoing upfront resection for resectable and borderline-resectable PDAC from 10/2001 to 12/2011 were identified from a prospective database. Actual overall survival was assessed after a follow-up of at least 5 years. Uni- and multivariable logistic regression analyses were performed.

RESULTS:

Median survival of 937 patients was 22.1 months. The actual 5YS rate was 17.0% (n = 159) including 89 (9.5%) patients without evidence of disease >5 years after resection. 5YS rates in patients with or without adjuvanttherapy were 18.8% vs. 12.2%, respectively. Tumorgrading, number of positive lymph nodes, a context of intraductal papillary mucinous neoplasia, and vascular resections were independently associated with 5YS. Patient-related parameters and CA 19-9 levels were associated with observed survival up to 3 years, but lost relevance thereafter. The extent of lymph node involvement was the strongest predictor of 5YS. Patients with pN0R0 had a 5YS rate of 38.2%. in patients with exclusively favorable factors the observed 5YS rate was above 50%.

CONCLUSIONS:

This is the largest series of long-term survivors with histologically confirmed PDAC. With upfront resection and adjuvant therapy an actual overall 5YS rate of 18.8% can be expected. in favorable subgroups actual 5YS is above 50%.

• Authors: Oliver Strobel, Philipp Lorenz, Ulf Hinz, Matthias Gaida, Anna-Katharina König, Thomas Hank, Willem Niesen, J Ö Rg Kaiser, Mohammed Al-Saeedi, Frank Bergmann, Christoph Springfeld, Christoph Berchtold, Markus K Diener, Martin Schneider, Arianeb Mehrabi, Beat P Müller-Stich, Thilo Hackert, Dirk Jager, Markus W Büchler
• Journal: Annals of surgery (Ann Surg) Vol. 275 Issue 5 Pg. 962-971 (05 01 2022) ISSN: 1528-1140 [Electronic] United States
• PMID: 32649469 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Adenocarcinoma (surgery)
• Carcinoma, Pancreatic Ductal (pathology)
• Humans
• Neoadjuvant Therapy
• Pancreatectomy
• Pancreatic Neoplasms (pathology)
• Survival Rate
• Pancreatic Neoplasms