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Long-Term Survivors after Upfront Resection for Pancreatic Ductal Adenocarcinoma: An Actual 5-Year Analysis of Disease-Specific and Post-Recurrence Survival

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Data on long-term actual survival in patients with surgically resected pancreatic ductal adenocarcinoma (PDAC) are limited. The aim of this study was to evaluate the actual 5-year disease-specific survival (DSS) and post-recurrence survival (PRS) in patients who underwent pancreatectomy for PDAC.

Methods

Data from patients who underwent upfront surgical resection for PDAC between 2009 and 2014 were analyzed. Exclusion criteria included PDAC arising in the background of an intraductal papillary mucinous neoplasm and patients undergoing neoadjuvant therapy. All alive patients had a minimum follow-up of 60 months. Independent predictors of PRS, DSS, and survival > 5 years were searched.

Results

Of the 176 patients included in this study, 48 (27%) were alive at 5 years, but only 20 (11%) had no recurrence. Median PRS was 12 months. In the 154 patients after disease recurrence, independent predictors of shorter PRS were total pancreatectomy, G3 tumors, early recurrence (< 12 months from surgery), and no treatment at recurrence. Median DSS was 36 months. Independent predictors of DSS were CA19-9 at diagnosis > 200 U/mL, total pancreatectomy, N + status, G3 tumors and perineural invasion. Only the absence of perineural invasion was a favorable independent predictor of survival > 5 years.

Conclusion

More than one-quarter of patients who underwent upfront surgery for PDAC were alive after 5 years, although only 11% of the initial cohort were cancer-free. Long-term survival can also be achieved in tumors with more favorable biology in an upfront setting followed by adjuvant chemotherapy.

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Funding

The PhD Scholarship of Giulia Gasparini and the Research Fellowship of Giulio Belfiori were supported by the Gioja Bianca Costanza Fund, and the research fellowship of Francesca Aleotti was supported by FCSR-Fronzaroli.

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Authors and Affiliations

  1. Division of Pancreatic Surgery, Department of Surgery, Pancreas Translational and Clinical Research Center, Università Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Giulio Belfiori MD, Stefano Crippa MD, PhD, Aleotti Francesca MD, Michele Pagnanelli MD, Domenico Tamburrino MD, PhD, Giulia Gasparini MD, PhD student, Stefano Partelli MD, PhD, Valentina Andreasi MD, PhD student & Massimo Falconi MD

  2. Department of Pathology, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy

    Corrado Rubini MD

  3. Department of Pathology, Ospedale Sacro Cuore-Don Calabria, Negrar, Italy

    Giuseppe Zamboni MD

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Correspondence to Stefano Crippa MD, PhD.

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Giulio Belfiori, Stefano Crippa, Aleotti Francesca, Michele Pagnanelli, Domenico Tamburrino, Giulia Gasparini, Stefano Partelli, Valentina Andreasi, Corrado Rubini, Giuseppe Zamboni, and Massimo Falconi report no conflicts of interests.

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SUPPLEMENTARY FIG. 1

DSS of the entire cohort. Median DSS was 36 months for all 176 patients. DSS disease-specific survival

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Belfiori, G., Crippa, S., Francesca, A. et al. Long-Term Survivors after Upfront Resection for Pancreatic Ductal Adenocarcinoma: An Actual 5-Year Analysis of Disease-Specific and Post-Recurrence Survival. Ann Surg Oncol 28, 8249–8260 (2021). https://doi.org/10.1245/s10434-021-10401-7

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