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WHAT IS THE KEY TO LONG TERM SURVIVAL IN RESECTABLE PANCREAS CANCER? A SURVIVAL ANALYSIS OF THE NATIONAL CANCER DATABASE
Julien Hohenleitner
*2, Oliver Standring
2, Emma Gazzara
2, Shruti Koti
2, Alex Liu
1, Gerardo Vitiello
2, Sepideh Gholami
2, Matthew Weiss
2, Danielle K. DePeralta
21SUNY Downstate Health Sciences University, New York, NY; 2Northwell Health, New Hyde Park, NY
IntroductionPancreatic Ductal Adenocarcinoma (PDAC) long-term survival is rare. A multimodal approach with a combination of surgical resection and systemic chemotherapy is standard of care. In this study we present an analysis of patients with non-metastatic PDAC that underwent a variety of treatments, in order to investigate factors associated with long-term survival (>10 years).
MethodsA retrospective review of the NCDB from 2004-2019 was performed in which all patients diagnosed with non-metastatic PDAC who underwent curative-intent surgical resection were included. Patient median overall survival (mOS) and 10-year survival was analyzed using Kaplan Meier method. Statistical significance was set at p < 0.05.
Results44,245 patients were included with 36,327 (82%) patients receiving upfront resection (UR) and 7,918 (18%) receiving NAT. UR patients had a mOS:20.9mo and 10 year survival (10yr) of 11.4%. NAT was associated with slightly longer overall survival (mOS :28.8mo, 10yr:14.2%) (p<.001). In patients that underwent UR, R0 margin was associated with increased survival (mOS: 23.8mo,10yr 13.5%) vs R1 (mOS: 15.1mo, 10yr: 4.9%) (p<.001). As expected, stage of disease and margin status are important predictors of OS and 10-year survival. Patients with stage I PDAC and negative surgical margins have the most favorable prognosis (mOS:48.8mo, 10yr: 28.7%). However this decreased in Stage II (mOS:21.9mo, 10yr: 10.7%) and Stage III(mOS:16.6mo,10yr:8.0%). This trend continued in R0 patients when stratified by adjuvant therapy: Stage I/adjuvant chemotherapy (AC) (mOS:62.5mo, 10yr: 35.1%), Stage I Adjuvant Chemotherapy and Radiation (ACR) (mOS: 55.0mo, 10yr: 29.0%), Stage II AC (mOS: 24.7, 10yr: 11.0%) and Stage II ACR (mOS: 26.2mo, 10yr: 13.3%). This significant decrease in mOS/10yr survival is seen consistently in higher stages and positive margins in patients who received upfront surgery. (Figure 1). Stage I, UR, with R0 margins who received no adjuvant treatment had a similar rate of 10 year survival to those who received AC/ACR, yet the mOS was much decreased. (mOS: 27.6mo, 10yr: 24.2%). NAT patients who received chemotherapy and radiation prior to resection (mOS: 28.9mo, 10 yr: 14.1%) had similar outcomes to those who received just NAT chemotherapy (mOS: 28.7mo, 10yr: 14,6%). In the NAT group, a higher rate of 10yr survival was seen in those with lower stage disease and R0 margins similar to the upfront surgery group.
ConclusionLong term survival is rare in pancreas cancer. The best outcomes are achieved with early stage disease, margin negative resection, and completion of chemotherapy. Improved strategies for early detection and improved systemic therapy are desperately needed.
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