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National Cancer Database Analysis Identifies Characteristics of 10-Year Survivors of Pancreatic Ductal Adenocarcinoma

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Key Points

  • Predictors of long-term survival included positive lymph node ratio, adjuvant chemotherapy, and T stage.
  • The nomogram predicted an 18.1% chance of ≥ 10-year survival in patients with the most favorable characteristics. 

In an analysis reported in JAMA Surgery, Paniccia et al identified patient and treatment characteristics that were associated with survival of at least 10 years after diagnosis of invasive pancreatic ductal adenocarcinoma, including lower positive lymph node ratio, receipt of adjuvant chemotherapy, and lower pathologic T stage. A predictive nomogram was constructed based on the analysis.

Study Details

The study involved National Cancer Database data from patients with histologically proven disease who underwent pancreatic surgical resection to remove primary tumor between January 1998 and December 2002, with follow-up through December 2011. Multivariate logistic regression analysis identified factors significantly associated with long-term survival, which were used to construct a nomogram predicting the likelihood of surviving at least 10 years.

Factors Associated With Long-Term Survival

Among 11,081 patients with complete survival information, 431 (3.9%) were long-term survivors. On multivariate analysis, significant predictors of long-term survival included lymph node positivity ratio of 0% (odds ratio [OR] = 4.66, 95% confidence interval [CI] = 3.4–6.4) and 1% to 20% (OR = 3.5, 95% CI = 2.5–5.0) vs > 20%; adjuvant chemotherapy (OR = 2.4, 95% CI = 2.0–3.0, vs no chemotherapy); pathologic T stage of T1 (OR = 3.1, 95% CI = 0.8–5.6, vs T4); patient age of 50 to 59 years (OR = 3.4, 95% CI = 1.8–6.7, vs > 80 years); tumor grade of well differentiated (OR = 2.2, 95% CI = 1.5–3.0, vs poorly differentiated); negative surgical margin (OR = 1.9, 95% CI = 1.4–2.6, vs positive), pathologic M stage of X (OR = 5.6, 95% CI = 2.1–22.8, vs 1); tumor size < 2 cm (OR = 1.7, 95% CI = 1.2–2.5, vs > 4 cm); and area with educational level of > 86% high school graduates (OR = 1.7, 95% CI = 1.2–2.4, vs area with < 71%).

Based on the nomogram derived from the multivariate logistic regression model (which assigned points for characteristics), patients with the most favorable characteristics had an 18.1% chance of long-term survival. The model C index was 0.768. In addition, survival curve analysis showed that the probability of dying following initial diagnosis reached a plateau of approximately 10% per year after 7 years of survival.

The investigators concluded, “Although [pancreatic ductal adenocarcinoma] remains a deadly disease, long-term survival is possible, even beyond the 10-year mark. Our adjusted analysis identified lymph node ratio, administration of adjuvant chemotherapy, and pathologic T stage as being the top 3 variables associated with [long-term survival] of [pancreatic ductal adenocarcinoma]. In addition, our easy-to-use nomogram may be able to identify potential [long-term survival] among patients with resected [pancreatic ductal adenocarcinoma].”

The authors reported no conflicts of interest.

Csaba Gajdos, MD, of University of Colorado, Aurora, is the corresponding author for the JAMA Surgery article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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