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. 2016 Jun;159(6):1520-1527.
doi: 10.1016/j.surg.2015.12.024. Epub 2016 Feb 2.

Long-term survival in patients with pancreatic ductal adenocarcinoma

Alexander P Stark  1 , Greg D Sacks  2 , Matthew M Rochefort  2 , Timothy R Donahue  1 , Howard A Reber  1 , James S Tomlinson  2 , David W Dawson  3 , Guido Eibl  1 , O Joe Hines  4
Affiliations

Long-term survival in patients with pancreatic ductal adenocarcinoma

Alexander P Stark et al. Surgery. 2016 Jun.

Abstract

Background: Long-term survival (LTS) is uncommon for patients with pancreatic ductal adenocarcinoma (PDAC). We sought to identify factors that predict 10-year, LTS after resection of PDAC.

Methods: We identified all patients with PDAC who underwent resection at UCLA after 1990 and included all patients eligible for observed LTS (1/1/1990-12/31/2004). An independent pathologist reconfirmed the diagnosis of PDAC in patients with LTS. Logistic regression was used to predict LTS on the basis of patient and tumor characteristics.

Results: Of 173 included patients, 53% were male, median age at diagnosis was 66 years, and median survival was 23 months. The rate of observed LTS was 12.1% (n = 21). Age, sex, number of lymph nodes evaluated, margin status, lymphovascular invasion, and adjuvant chemotherapy and radiation were not associated with LTS. The following were associated with LTS on bivariate analysis: low AJCC stage (Ia, Ib, IIa) (P = .034), negative lymph node status (P = .034), low grade (well-, moderately-differentiated) (P = .001), and absence of perineural invasion (P = .019). Only low grade (odds ratio 7.17, P = .012) and absent perineural invasion (odds ratio 3.28, P = .036) were independently associated with increased odds of LTS. Our multivariate model demonstrated good discriminatory power for LTS, as indicated by a c-statistic of 0.7856.

Conclusion: Absence of perineural invasion and low tumor grade were associated with greater likelihood of LTS. Understanding the tumor biology of LTS may provide critical insight into a disease that is typically marked by aggressive behavior and limited survival.

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Figures

Figure 1
Figure 1. Receiver operating characteristic curves for logistic regression models predicting LTS following pancreatic resection for pancreatic adenocarcinoma
Complete model, including perineural invasion, c-statistic = 0.7856. Model including AJCC stage plus tumor grade, c-statistic = 0.7548. Model including only AJCC stage, c-statistic 0.6314.
See this image and copyright information in PMC

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