Long-Term Survivors after Upfront Resection for Pancreatic Ductal Adenocarcinoma: An Actual 5-Year Analysis of Disease-Specific and Post-Recurrence Survival.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
11
05
2021
accepted:
14
05
2021
pubmed:
15
7
2021
medline:
18
11
2021
entrez:
14
7
2021
Statut:
ppublish
Résumé
Data on long-term actual survival in patients with surgically resected pancreatic ductal adenocarcinoma (PDAC) are limited. The aim of this study was to evaluate the actual 5-year disease-specific survival (DSS) and post-recurrence survival (PRS) in patients who underwent pancreatectomy for PDAC. Data from patients who underwent upfront surgical resection for PDAC between 2009 and 2014 were analyzed. Exclusion criteria included PDAC arising in the background of an intraductal papillary mucinous neoplasm and patients undergoing neoadjuvant therapy. All alive patients had a minimum follow-up of 60 months. Independent predictors of PRS, DSS, and survival > 5 years were searched. Of the 176 patients included in this study, 48 (27%) were alive at 5 years, but only 20 (11%) had no recurrence. Median PRS was 12 months. In the 154 patients after disease recurrence, independent predictors of shorter PRS were total pancreatectomy, G3 tumors, early recurrence (< 12 months from surgery), and no treatment at recurrence. Median DSS was 36 months. Independent predictors of DSS were CA19-9 at diagnosis > 200 U/mL, total pancreatectomy, N + status, G3 tumors and perineural invasion. Only the absence of perineural invasion was a favorable independent predictor of survival > 5 years. More than one-quarter of patients who underwent upfront surgery for PDAC were alive after 5 years, although only 11% of the initial cohort were cancer-free. Long-term survival can also be achieved in tumors with more favorable biology in an upfront setting followed by adjuvant chemotherapy.
Sections du résumé
BACKGROUND
BACKGROUND
Data on long-term actual survival in patients with surgically resected pancreatic ductal adenocarcinoma (PDAC) are limited. The aim of this study was to evaluate the actual 5-year disease-specific survival (DSS) and post-recurrence survival (PRS) in patients who underwent pancreatectomy for PDAC.
METHODS
METHODS
Data from patients who underwent upfront surgical resection for PDAC between 2009 and 2014 were analyzed. Exclusion criteria included PDAC arising in the background of an intraductal papillary mucinous neoplasm and patients undergoing neoadjuvant therapy. All alive patients had a minimum follow-up of 60 months. Independent predictors of PRS, DSS, and survival > 5 years were searched.
RESULTS
RESULTS
Of the 176 patients included in this study, 48 (27%) were alive at 5 years, but only 20 (11%) had no recurrence. Median PRS was 12 months. In the 154 patients after disease recurrence, independent predictors of shorter PRS were total pancreatectomy, G3 tumors, early recurrence (< 12 months from surgery), and no treatment at recurrence. Median DSS was 36 months. Independent predictors of DSS were CA19-9 at diagnosis > 200 U/mL, total pancreatectomy, N + status, G3 tumors and perineural invasion. Only the absence of perineural invasion was a favorable independent predictor of survival > 5 years.
CONCLUSION
CONCLUSIONS
More than one-quarter of patients who underwent upfront surgery for PDAC were alive after 5 years, although only 11% of the initial cohort were cancer-free. Long-term survival can also be achieved in tumors with more favorable biology in an upfront setting followed by adjuvant chemotherapy.
Identifiants
pubmed: 34258720
doi: 10.1245/s10434-021-10401-7
pii: 10.1245/s10434-021-10401-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
8249-8260Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. Society of Surgical Oncology.
Références
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7–30.
doi: 10.3322/caac.21590
Ferrone CR, Pieretti-Vanmarcke R, Bloom JP, et al. Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery. 2012. https://doi.org/10.1016/j.surg.2012.05.020 .
doi: 10.1016/j.surg.2012.05.020
pubmed: 23174008
pmcid: 3499282
Ferrone CR, Brennan MF, Gonen M, et al. Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg. 2008. https://doi.org/10.1007/s11605-007-0384-8 .
doi: 10.1007/s11605-007-0384-8
pubmed: 18704597
pmcid: 3806097
Groot VP, Gemenetzis G, Blair AB, et al. Defining and predicting early recurrence in 957 patients with resected pancreatic ductal adenocarcinoma. Ann Surg. 2019. https://doi.org/10.1097/SLA.0000000000002734 .
doi: 10.1097/SLA.0000000000002734
pubmed: 31082915
Katz MHG, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009. https://doi.org/10.1245/s10434-008-0295-2 .
doi: 10.1245/s10434-008-0295-2
pubmed: 19847566
pmcid: 3162375
He J, Ahuja N, Makary MA, et al. 2564 resected periampullary adenocarcinomas at a single institution: trends over three decades. HPB. 2014. https://doi.org/10.1111/hpb.12078 .
doi: 10.1111/hpb.12078
pubmed: 25327281
pmcid: 4333791
Rich JT, Neely JG, Paniello RC, et al. A practical guide to understanding Kaplan–Meier curves. Otolaryngol Head Neck Surg. 2010. https://doi.org/10.1016/j.otohns.2010.05.007 .
doi: 10.1016/j.otohns.2010.05.007
pubmed: 20723767
pmcid: 3932959
Strobel O, Lorenz P, Hinz U, et al. Actual five-year survival after upfront resection for pancreatic ductal adenocarcinoma. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000004147 .
doi: 10.1097/SLA.0000000000004147
pubmed: 33055587
Bengtsson A, Andersson R, Ansari D. The actual 5-year survivors of pancreatic ductal adenocarcinoma based on real-world data. Sci Rep. 2020. https://doi.org/10.1038/s41598-020-73525-y .
doi: 10.1038/s41598-020-73525-y
pubmed: 33219291
pmcid: 7679414
Nakagawa K, Akahori T, Nishiwada S, et al. Prognostic factors for actual long-term survival in the era of multidisciplinary treatment for pancreatic ductal adenocarcinoma. Langenbeck’s Arch Surg. 2018. https://doi.org/10.1007/s00423-018-1709-7 .
doi: 10.1007/s00423-018-1709-7
Yamaguchi K. Pancreatic ductal carcinoma derived from IPMN and concomitant with IPMN. Nihon Rinsho. 2015;73:234–9.
pubmed: 25857022
Qaderi SM, Dickman PW, de Wilt JHW, et al. Conditional survival and cure of patients with colon or rectal cancer: a population-based study. J Natl Compr Canc Netw. 2020. https://doi.org/10.6004/jnccn.2020.7568 .
doi: 10.6004/jnccn.2020.7568
pubmed: 32886900
Klaiber U, Hackert T, Neoptolemos JP. Adjuvant treatment for pancreatic cancer. Transl Gastroenterol Hepatol. 2019. https://doi.org/10.21037/tgh.2019.04.04 .
doi: 10.21037/tgh.2019.04.04
pubmed: 31143848
pmcid: 6509427
Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open label, randomised, phase 3 trial. Lancet. 2017. https://doi.org/10.1016/s0140-6736(16)32409-6 .
doi: 10.1016/s0140-6736(16)32409-6
pubmed: 28422026
Neoptolemos JP, Moore MJ, Cox TF, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs. observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012. https://doi.org/10.1001/jama.2012.7352 .
doi: 10.1001/jama.2012.7352
pubmed: 22782416
Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs. gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA. 2010. https://doi.org/10.1001/jama.2010.1275 .
doi: 10.1001/jama.2010.1275
pubmed: 20823433
Edge S, Byrd DR, Compton CC, et al editors. AJCC cancer staging manual. 7th edn. New York: Springer; 2010.
Verbeke CS, Gladhaug IP. Resection margin involvement and tumour origin in pancreatic head cancer. Br J Surg. 2012. https://doi.org/10.1002/bjs.8734 .
doi: 10.1002/bjs.8734
pubmed: 22517199
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004. https://doi.org/10.1097/01.sla.0000133083.54934.ae .
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15570203
pmcid: 1356513
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017. https://doi.org/10.1016/j.surg.2016.11.014 .
doi: 10.1016/j.surg.2016.11.014
pubmed: 28676333
Barugola G, Partelli S, Marcucci S, et al. Resectable pancreatic cancer: who really benefits from resection? Ann Surg Oncol. 2009. https://doi.org/10.1245/s10434-009-0670-7 .
doi: 10.1245/s10434-009-0670-7
pubmed: 19707831
Gemenetzis G, Groot VP, Blair AB, et al. Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma. J Surg Oncol. 2018. https://doi.org/10.1002/jso.25288 .
doi: 10.1002/jso.25288
pubmed: 30380143
Huang J, Lok V, Ngai CH, et al. Worldwide burden of, risk factors for, and trends in pancreatic cancer. Gastroenterology. 2020. https://doi.org/10.1053/j.gastro.2020.10.007 .
doi: 10.1053/j.gastro.2020.10.007
pubmed: 33387517
pmcid: 7731467
Mohammadian-Hafshejani A. The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2019. https://doi.org/10.1016/s2468-1253(19)30347-4 .
doi: 10.1016/s2468-1253(19)30347-4
Søreide K, Aagnes B, Møller B, Westgaard A, Bray F. Epidemiology of pancreatic cancer in Norway: trends in incidence, basis of diagnosis and survival 1965–2007. Scand J Gastroenterol. 2010. https://doi.org/10.3109/00365520903358899 .
doi: 10.3109/00365520903358899
pubmed: 20735155
Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013. https://doi.org/10.1001/jama.2013.279201 .
doi: 10.1001/jama.2013.279201
pubmed: 24104372
Søreide K. Neoadjuvant and adjuvant therapy in operable pancreatic cancer: both honey and milk (but no bread?). Oncol Ther. 2021. https://doi.org/10.1007/s40487-020-00136-y .
doi: 10.1007/s40487-020-00136-y
pubmed: 33759076
pmcid: 8140037
Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018. https://doi.org/10.1056/NEJMoa1809775 .
doi: 10.1056/NEJMoa1809775
pubmed: 30575490
Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma: clinicopathologic analysis of 5-year survivors. Ann Surg. 1996. https://doi.org/10.1097/00000658-199603000-00007 .
doi: 10.1097/00000658-199603000-00007
pubmed: 8604907
pmcid: 1235115
Cleary SP, Gryfe R, Guindi M, et al. Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am Coll Surg. 2004. https://doi.org/10.1016/j.jamcollsurg.2004.01.008 .
doi: 10.1016/j.jamcollsurg.2004.01.008
pubmed: 15110805
Han SS, Jang JY, Kim SW, Kim WH, Lee KU, Park YH. Analysis of long-term survivors after surgical resection for pancreatic cancer. Pancreas. 2006. https://doi.org/10.1097/01.mpa.0000202953.87740.93 .
doi: 10.1097/01.mpa.0000202953.87740.93
pubmed: 16804407
Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma is cure possible? Ann Surg. 2008. https://doi.org/10.1097/SLA.0b013e3181613142 .
doi: 10.1097/SLA.0b013e3181613142
pubmed: 18376190
Crippa S, Guarneri G, Belfiori G, et al. Positive neck margin at frozen section analysis is a significant predictor of tumour recurrence and poor survival after pancreatodudenectomy for pancreatic cancer. Eur J Surg Oncol. 2020. https://doi.org/10.1016/j.ejso.2020.02.013 .
doi: 10.1016/j.ejso.2020.02.013
pubmed: 33176959
Kooby DA, Lad NL, Squires MH, et al. Value of intraoperative neck margin analysis during Whipple for pancreatic adenocarcinoma: a multicenter analysis of 1399 patients. Ann Surg. 2014. https://doi.org/10.1097/SLA.0000000000000890 .
doi: 10.1097/SLA.0000000000000890
pubmed: 25115425
Datta J, Willobee BA, Ryon EL, et al. Contemporary reappraisal of intraoperative neck margin assessment during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a review. JAMA Surg. 2021. https://doi.org/10.1001/jamasurg.2020.5676 .
doi: 10.1001/jamasurg.2020.5676
pubmed: 33533898
Morales-Oyarvide V, Rubinson DA, Dunne RF, et al. Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival. Br J Cancer. 2017. https://doi.org/10.1038/bjc.2017.349 .
doi: 10.1038/bjc.2017.349
pubmed: 28982112
pmcid: 5729468
Honselmann KC, Pergolini I, Fernandez-Del Castillo C, et al. Timing but not patterns of recurrence is different between node-negative and node-positive resected pancreatic cancer. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000003123 .
doi: 10.1097/SLA.0000000000003123
pubmed: 33086324
Crippa S, Partelli S, Zamboni G, et al. Poorly differentiated resectable pancreatic cancer: is upfront resection worthwhile? Surgery. 2012. https://doi.org/10.1016/j.surg.2012.05.017 .
doi: 10.1016/j.surg.2012.05.017
pubmed: 23261026
Crippa S, Pergolini I, Javed AA, et al. Implications of perineural invasion on disease recurrence and survival after pancreatectomy for pancreatic head ductal adenocarcinoma. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000004464 .
doi: 10.1097/SLA.0000000000004464
pubmed: 33086324
Schorn S, Demir IE, Haller B, et al. The influence of neural invasion on survival and tumor recurrence in pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Surg Oncol. 2017. https://doi.org/10.1016/j.suronc.2017.01.007 .
doi: 10.1016/j.suronc.2017.01.007
pubmed: 28317579
Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011. https://doi.org/10.1056/NEJMoa1011923 .
doi: 10.1056/NEJMoa1011923
pubmed: 21561347
Suker M, Beumer BR, Sadot E, et al. FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Lancet Oncol. 2016. https://doi.org/10.1016/S1470-2045(16)00172-8 .
doi: 10.1016/S1470-2045(16)00172-8
pubmed: 27160474
pmcid: 5527756
Peretti U, Cavaliere A, Niger A, et al. Germinal BRCA1-2 pathogenic variants (gBRCA1-2pv) and pancreatic cancer:epidemiology of an Italian patient cohort. ESMO Open. 2021. https://doi.org/10.1016/j.esmoop.2020.100032 .
doi: 10.1016/j.esmoop.2020.100032
pubmed: 34392104
pmcid: 8371213