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. 2019 Dec;24(12):1543-1548.
doi: 10.1634/theoncologist.2018-0786. Epub 2019 Jun 4.

Long-Term Survivors in Metastatic Pancreatic Ductal Adenocarcinoma: A Retrospective and Matched Pair Analysis

Pauline Rochefort  1 , Audrey Lardy-Cleaud  2 , Matthieu Sarabi  3 , Françoise Desseigne  3 , Anne Cattey-Javouhey  3 , Christelle de la Fouchardière  3
Affiliations

Long-Term Survivors in Metastatic Pancreatic Ductal Adenocarcinoma: A Retrospective and Matched Pair Analysis

Pauline Rochefort et al. Oncologist. 2019 Dec.

Abstract
in English, Chinese

Background: Metastatic pancreatic ductal adenocarcinoma (mPDAC) is an aggressive malignancy with a median overall survival (OS) of between 8 and 11 months. However, a significant number of patients experience a longer survival, more than 18 months. The aim of this study was to describe the "long-term survivor" population and to evaluate clinical and pathological factors that might affect survival.

Materials and methods: All patients with mPDAC diagnosed in the Centre Leon Bérard (Lyon, France) between January 2010 and June 2015 and who survived more than 18 months were identified. They were compared with a control cohort matched on age, sex, performance status, stage at diagnosis, primary tumor localization, treatment, and liver metastasis. Their clinical features, treatment modalities, and outcomes were analyzed.

Results: A total of 94 patients were included, 47 in each cohort. Both cohorts had identical characteristics as follows: women (51%), performance status ≤1 (95.7%), median age at diagnosis (60 years), and metastasis at diagnosis (83%). Median OS was 26.87 months (95% confidence interval [CI] 23-31.08) in the long-term survivor group (LS group) and 9.79 months (95% CI 5.75-11.86) in the control group (C group). Potential factors of long-term survival were explored with a logistic model (LS group vs. C group). Three factors were identified as significant prognostic factors in the univariate analysis: lymphopenia (odds ratio [OR] ref: yes = 0.26), neutrophil-to-lymphocyte ratio (NLR; OR ref >5 = 0.31), and peritoneal carcinomatosis (OR ref: yes = 0.40). NLR was the only remaining factor in our backward selection procedure.

Conclusion: A significant subset of patients with mPDAC can achieve long-term survival (≥18 months) in 2018. We identified low NLR as a significant prognostic factor associated with long-term survival in mPDAC.

Implications for practice: Metastatic pancreatic ductal adenocarcinoma (mPDAC) is one of the most lethal types of cancer. A subset of patients with mPDAC can achieve long-term survival (≥18 months) with a modern chemotherapy regimen, such as FOLFIRINOX or gemcitabine/nab-paclitaxel. We identified low neutrophil-to-lymphocyte ratio (NLR) as a significant prognostic factor associated with long-term survival in mPDAC. Prognostic factors such as NLR might allow accurate selection of patients with mPDAC in order to consider individual therapeutic approaches. NLR should be used as a stratification factor in clinical trials.

摘要

背景。转移性胰腺导管腺癌 (mPDAC) 是一种侵袭性恶性肿瘤，中位总生存期 (OS) 为 8 至 11 个月。然而，许多患者的生存期较长，超过 18 个月。本研究的目的是描述“长期生存者”群体，并评估可能影响生存期的临床和病理因素。

材料和方法。面向 2010 年 1 月至 2015 年 6 月期间在里昂贝拉德中心(Centre Leon Bérard，法国里昂)确诊为mPDAC且生存期超过 18 个月的所有患者。将这些患者与在年龄、性别、体力状态、诊断分期、原发肿瘤位置、治疗及肝转移方面相匹配的对照队列进行了对比。对他们的临床特征、治疗方式及预后进行了分析。

结果。共纳入 94 例患者，每个队列 47 例。两个队列的患者具有相同的特征，具体如下:女性 (51%)、体力状态≤1 (95.7%)、确诊时的中位年龄(60 岁)，以及确诊时的转移率 (83%)。长期生存者组(LS 组)的中位OS为 26.87 个月 [95% 置信区间 (CI)23‐31.08]，对照组(C 组)为 9.79 个月(95% 置信区间 5.75‐11.86)。通过利用逻辑模型，研究了影响长期生存的潜在因素(LS 组与 C 组)。在单变量分析中，确定了影响预后的三个重要因素:淋巴细胞减少 [优势比 (OR)ref: yes = 0.26]、中性粒细胞与淋巴细胞比(NLR；OR ref >5 = 0.31)，以及腹膜癌(OR ref: yes = 0.40)。在我们的逆向选择过程中， NLR 是唯一剩下的因素。

结论。2018 年，mPDAC患者中的大部分人可实现长期生存(≥18 个月)。我们发现，较低的NLR是与mPDAC患者长期生存相关的一个重要预后因素。

实践意义:转移性胰腺导管腺癌 (mPDAC) 是最致命的癌症之一。通过现代化疗方案(例如 FOLFIRINOX 或吉西他滨 / 白蛋白结合型紫杉醇)， mPDAC患者中的一部分人可实现长期生存(≥18 个月)。我们发现，较低的中性粒细胞与淋巴细胞比 (NLR) 是与mPDAC患者长期生存相关的一个重要预后因素。我们可利用NLR等影响预后的因素准确选择mPDAC患者，以考虑针对个体的治疗方法。在临床试验中，NLR应作为重要的分层因素。

Keywords: Long‐term survivors; Metastasis; Pancreatic ductal adenocarcinoma; Prognostic factors; Survival.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

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