Key Markers Predict Long-Term Pancreatic Cancer Survival

Nomogram pinpoints the patients most likely to achieve long-term survival after pancreatic ductal adenocarcinoma resection

  • Date: 11 Jun 2015
  • Author: Lynda Williams, Senior medwireNews Reporter
  • Topic: Pancreatic Cancer

medwireNews: Long-term survivors (LTSs) of pancreatic ductal adenocarcinoma (PADC) share key characteristics, say researchers who have created a nomogram to identify these rare patients in the clinic.

Just 3.9% of 11,081 patients who underwent primary tumour resection in the USA or Puerto Rico between 1998 and 2002 survived for 10 years or more, report Csaba Gajdos, from the University of Colorado Anschutz Medical Campus in Aurora, USA, and co-workers.

Using 10 variables found to be significantly prognostic of PADC survival in multivariable analysis, the researchers created a nomogram with a concordance index of 0.768. Patients with the optimal characteristics had an 18.1% probability of surviving for at least 10 years versus a less than 1.0% chance for patients with particularly poor criteria.

The strongest predictive factor of long-term survival was the lymph node positivity ratio (LNPR), calculated by dividing the number of lymph nodes with metastases by the number of nodes examined, the team reports in JAMA Surgery.

Half (51.0%) of LTSs had a LNPR of zero, indicating no positive lymph nodes, and in multivariate analysis, this was associated with a significant 4.6-fold increased likelihood of achieving 10-year survival compared with an LNPR of 20% or more.

The majority (62.4%) of LTSs received adjuvant chemotherapy and receipt was also a significant predictor of LTS, giving an odds ratio (OR) of 2.4.

In addition, LTS was predicted by pathological T stage (T1 vs T4, OR=3.1), young age (50–59 vs >80 years, OR=3.4), a well differentiated versus poorly differentiated tumour grade (OR=2.2), and a negative surgical margin (OR=1.9).

Pathological M stage, tumour size, educational attainment and insurance status were also significant predictors of outcome, the authors add.

Noting that almost half of patients were node-positive and 12.3% has positive surgical margins, the authors of an accompanying comment say the “highly commendable” study’s findings “underscore the importance of systemic therapy” and highlight the potential benefits associated with the increasing use of neoadjuvant therapy in pancreatic cancer.

Mu Xu and O Joe Hines, from the University of California, Los Angeles in the USA, suggest that the nomogram may also benefit from the inclusion of perioperative carbohydrate Antigen 19-9 level and the presence of perioperative complications, such as delayed gastric emptying or pancreatic fistula.

“Lowering postoperative morbidity through the consolidation of pancreatic cancer care to specialty centers is probably also contributing to improved long-term survival”, they write.

The commentators conclude: “With the advances in pancreatic cancer research and the growth of multidisciplinary management, we expect a growing number of patients will realize the benefits of incremental improvement in the management of this lethal disease.”

References

Paniccia A, Hosokawa P, Henderson W, et al. Characteristics of 10-year survivors of pancreatic ductal adenocarcinoma. JAMA Surg 2015; Advance online publication 10 June. doi:10.1001/jamasurg.2015.0668

Xu M, Hines OJ. Long-term survival after pancreatic cancer. Hope has arrived. JAMA Surg 2015; Advance online publication 10 June. doi:10.1001/jamasurg.2015.0702

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