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Five-Year Actual Overall Survival in Resected Pancreatic Cancer: A Contemporary Single-Institution Experience from a Multidisciplinary Perspective

  • Pancreatic Tumors
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Abstract

Background

Successful surgical resection combined with effective perioperative therapy is essential for maximizing long-term survival for pancreatic adenocarcinoma.

Patients and Methods

All patients with pancreatic adenocarcinoma who underwent curative resection at our institution from January 2003 to May 2010 were reviewed. Demographic and clinical details were retrospectively collected from medical records and cancer registry data.

Results

Overall, 176 patients were included in the analysis (148 with de novo resectable disease and 28 with borderline resectable disease at presentation). Among 106 patients who received all perioperative therapy at our institution, 94% received neoadjuvant and/or adjuvant treatment in addition to resection. Actual all-cause 5-year overall survival (OS) for all 176 patients was 30.7%, with a median OS of 33.9 months [95% confidence interval (CI) 28.1–39.6 months]. For patients who received all perioperative therapy at our institution, actual all-cause 5-year disease-free survival (DFS) was 32.1%, with a median DFS of 28.8 months (95% CI 20.1–43.6 months). Of these patients, 67/106 (63%) recurred: 8 (8%) locoregional only; 52 (49%) systemic only; and 7 (7%) combined recurrence. No difference in survival rates or recurrence patterns was seen between resectable and borderline resectable patients. In multivariate analysis, tumor differentiation (poor vs. non-poor) and lymph node ratio >20% produced a useful clinical model.

Conclusion

The actual OS rates for resected pancreatic cancer shown in this study are reflective of those currently achievable at a tertiary medical center dedicated to this patient population. In considering these results, both frequency and type of adjuvant/neoadjuvant therapy administered in the context of the clinical experience/management techniques of providers administering these treatments will be discussed.

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References

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  2. Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO- 001 randomized trial. JAMA. 2013;310:1473–81.

    Article  CAS  PubMed  Google Scholar 

  3. Picozzi VJ, Kozarek RA, Traverso LW. Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg. 2003;185:476–80.

    Article  PubMed  Google Scholar 

  4. Rocha FG, Hashimoto Y, Traverso LW, et al. Interferon-based adjuvant chemoradiation for resected pancreatic head cancer: long-term follow-up of the Virginia Mason Protocol. Ann Surg. 2016;263(2):376–84

    Article  PubMed  Google Scholar 

  5. Rose JB, Rocha FG, Alseidi A, et al. Extended neoadjuvant chemotherapy for borderline resectable pancreatic cancer demonstrates promising postoperative outcomes and survival. Ann Surg Oncol. 2014; 21:1530–37.

    Article  PubMed  Google Scholar 

  6. Katz MH, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kim R, Tsao R, Tan A, et.al. A single institution review of adjuvant therapy outcomes for resectable pancreatic adenocarcinoma: outcome and prognostic indicators J Gastrointest Surg. 2010;14(7):1159–69

    PubMed  Google Scholar 

  8. Winter JM, Brennan MF, Tang LH, et.al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19(1):169–75

    Article  PubMed  Google Scholar 

  9. Martin LK, Luu DC, Li X, et al. The addition of radiation to chemotherapy does not improve outcome when compared to chemotherapy in the treatment of resected pancreas cancer: the results of a single-institution experience. Ann Surg Oncol. 2014;21(3):862–7

    Article  PubMed  Google Scholar 

  10. Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA. 2010;304:1073–81.

    Article  CAS  PubMed  Google Scholar 

  11. Evans DB, Varadhachary GR, Crane CH, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3496–502.

    Article  CAS  PubMed  Google Scholar 

  12. Corsini MM, Miller RC, Haddock MG, et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975–2005). J Clin Oncol. 2008;26:3503–10.

    Article  Google Scholar 

  13. Clark CJ, Traverso LW. Positive peritoneal lavage cytology is a predictor of worse survival in locally advanced pancreatic cancer. Am J Surg. 2010:199(5):657–62.

    Article  PubMed  Google Scholar 

  14. Hashimoto Y, Traverso, LW Pancreatic anastomotic failure rate is improved after microsurgery. J Am Coll Surg. 2010;211(4):510–21

    Article  PubMed  Google Scholar 

  15. Jacobs AD, Otero HO, Malpass TA, et al. Gemcitabine combined with docetaxel for the treatment of metastatic pancreas cancer. Cancer Invest. 2004;22:505–14.

    Article  CAS  PubMed  Google Scholar 

  16. Bilimoria KY, Bentrem DJ, Ko CY, et al. Multimodality therapy for pancreatic cancer in the U.S.: utilization, outcomes, and the effect of hospital volume. Cancer. 2007;110:1227–34.

    Article  PubMed  Google Scholar 

  17. Visser BC, Ma Y, Zak Y et al. Failure to comply with NCCN guidelines for the management of pancreatic cancer compromises outcomes. HPB (Oxf). 2012;14:539–47

    Article  Google Scholar 

  18. Gooiker GA, Lemmens VE, Besselink MG, et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg. 2014;101:1000–5.

    Article  CAS  PubMed  Google Scholar 

  19. Neoptolemos JP, Palmer D, Ghaneh P et al. ESPAC-4: a multicenter, international, open-label randomized controlled phase III trial of adjuvant combination chemotherapy of gemcitabine (GEM) and capecitabine (CAP) versus monotherapy gemcitabine in patients with resected pancreatic ductal adenocarcinoma. J Clin Oncol. 2016;34 Suppl. (abstract no. LBA4006)

  20. Picozzi VJ, Abrams RA, Decker PA, et al. Multicenter phase II trial of adjuvant therapy for resected pancreatic cancer using cisplatin, 5-FU and interferon-alpha-2b-based chemoradiation. Ann Oncol. 2011;22:348–54

    Article  CAS  PubMed  Google Scholar 

  21. Schmidt J, Abel U, Debus J, et al. Open-label, multicenter, randomized phase III trial of adjuvant chemoradiation plus interferon alfa-2b versus fluorouracil and folinic acid for patients with resected pancreatic adenocarcinoma. J Clin Oncol. 2012;30:4077–83.

    Article  CAS  PubMed  Google Scholar 

  22. Hsu CC, Herman JM, Corsini MM et al. Adjuvant chemoradiation for resected pancreatic cancer: the Johns Hopkins Hospital/Mayo Clinic collaborative study. Ann Surg Oncol. 2010;17(4):981–90

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bang S, Chung HW, Park SW, et al. The usefulness of 18-fluorodeoxyglucose positron emission tomography in the differential diagnosis, staging, and response evaluation after concurrent chemoradiotherapy for pancreatic cancer. J Clin Gastro. 2006;40:923–9.

    Article  Google Scholar 

  24. Whittle MC, Izeradjene K, Rani PG, et al. RUNX3 controls a metabolic switch in pancreatic ductal adenocarcinoma. Cell. 2015;161:1345–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Whatcott CJ, Han H, vonHoff DD. Orchestrating the tumor microenvironment to improve survival for patients with pancreatic cancer: normalization, not destruction. Cancer J. 2015;21:299–306.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Jamieson NB, Glen P, McMillan DC, et al. Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas. Br J Cancer. 2005;92:21–3.

    Article  CAS  PubMed  Google Scholar 

  27. Bachmann J, Heiligensetzer M, Krakowski-Roosen H, Büchler MW, Friess H, Martignoni ME. Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointestinal Surg. 2008;12:1193–201.

    Article  Google Scholar 

  28. Dalal S, Hui D, Bidaut L, et al. relationships among body mass index, longitudinal body composition alterations, and survival in patients with locally advanced pancreatic cancer receiving chemoradiation: a pilot study. J Pain Symptom Manag. 2012;44:181–91.

    Article  Google Scholar 

  29. Tan BHL, Birdsell LA, Martin L, Baracos VE, Fearon KC. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res. 2009;15:6973–79.

    Article  CAS  PubMed  Google Scholar 

  30. O’Reilly EM, Smith LS, Bendell JB, et al. Final results of phase Ib of anticancer stem cell antibody tarextumab (OMP-59R5, TRXT, anti-Notch 2/3) in combination with nab-paclitaxel and gemcitabine (Nab-P + Gem) in patients (pts) with untreated metastatic pancreatic cancer (mPC). J Clin Oncol. 2015;33 Suppl 3 (abstract no. 278).

  31. Wang-Gillam A, Li CP, Bodoky G et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet Oncol. 2016;387:545–57.

    Article  CAS  Google Scholar 

  32. Moore MH, Goldstein D, Hamm J, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–66.

    Article  CAS  PubMed  Google Scholar 

  33. Hingorani SR, Harris WH, Hendifar AE, et al. High response rate and PFS with PEGPH20 added to nab-paclitaxel/gemcitabine in stage IV previously untreated pancreatic cancer patients with high-HA tumors: Interim results of a randomized phase II study. J Clin Oncol. 2015;33 Suppl (abstract no. 4006).

  34. Le DT, Wang–Gillam A, Picozzi VJ, et al. Safety and survival with GVAX pancreas prime and listeria monocytogenes-expressing mesothelin (CS-207) boost vaccines for metastatic pancreas cancer. J Clin Oncol. 2015;33:1325–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was supported by generous gifts from our patients.

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Correspondence to Vincent J. Picozzi.

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Picozzi, V.J., Oh, S.Y., Edwards, A. et al. Five-Year Actual Overall Survival in Resected Pancreatic Cancer: A Contemporary Single-Institution Experience from a Multidisciplinary Perspective. Ann Surg Oncol 24, 1722–1730 (2017). https://doi.org/10.1245/s10434-016-5716-z

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  • DOI: https://doi.org/10.1245/s10434-016-5716-z

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