A Retrospective Analysis of Long-Term Survivors with Metastatic Pancreatic Ductal Adenocarcinoma
Authors: H. Hayashi, S. Kondo, S. Shiba, Y. Sakamoto, C. Morizane, H. Ueno, T. Okusaka
Journal: Annals of Oncology (2013)

Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is highly malignant and has a short median overall survival of 5-11 months. However, a subgroup of patients are able to achieve prolonged survival, with a few reports describing patients who survived for more than a year. Considering the recent improvements in treatment outcomes, analyses of even longer-term survivors are needed.Methods: A cohort of 256 patients who had received chemotherapy for metastatic PDAC (excluding recurrent cases) at the National Cancer Center Hospital between April 2007 and October 2011 were recruited. We defined 44 (17%) patients who had survived for more than 500 days after the initial chemotherapy as long-term survivors and investigated their clinicopathological characteristics.Results: The median age of the patients (21 males, 23 females) was 64 years.They had a baseline ECOG performance status of 0/1/2 in 22/21/1 patients and a histopathological grade of well/moderately/poorly/unknown in 1/16/8/19, respectively. The primary tumor was located in the head of the pancreas in 17 patients and the body or tail of the pancreas in 27. Ten patients had been treated for pain at baseline, and 9 had undergone biliary drainage prior to the initial chemotherapy. Liver/ lymph node/lung/peritoneum/bone metastases were present in 22/19/10/9/1 patients, respectively. The number of metastatic sites was 1/2/3 in 28/15/1 patients, respectively. The first-line chemotherapy regimens were GEM/GEM + S-1/S-1/GEM + Erlotinib/others in 28/10/2/1/3 patients, respectively. Second-line chemotherapy was performed in 28 patients (64%).The objective response rate to the first-line chemotherapy was 41%, and the disease control rate was 98%. The median overall survival was 23.4 months, and the median progression-free survival was 12.2 months. A multivariate analysis using the Cox proportional hazard model showed age (<70 years), sex (female), and WBC (<6000/&mgr;L) to be independent predictors of a longer survival.Conclusions: This retrospective analysis demonstrated that many long-term survivors have an objective tumor response to the first-line chemotherapy and live for almost a year, even after the failure of initial chemotherapy. Age (<70 years), sex (female), and WBC (<6000/&mgr;L) were predictors of a longer survival in this population. Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is highly malignant and has a short median overall survival of 5-11 months. However, a subgroup of patients are able to achieve prolonged survival, with a few reports describing patients who survived for more than a year. Considering the recent improvements in treatment outcomes, analyses of even longer-term survivors are needed. Methods: A cohort of 256 patients who had received chemotherapy for metastatic PDAC (excluding recurrent cases) at the National Cancer Center Hospital between April 2007 and October 2011 were recruited. We defined 44 (17%) patients who had survived for more than 500 days after the initial chemotherapy as long-term survivors and investigated their clinicopathological characteristics. Results: The median age of the patients (21 males, 23 females) was 64 years.They had a baseline ECOG performance status of 0/1/2 in 22/21/1 patients and a histopathological grade of well/moderately/poorly/unknown in 1/16/8/19, respectively. The primary tumor was located in the head of the pancreas in 17 patients and the body or tail of the pancreas in 27. Ten patients had been treated for pain at baseline, and 9 had undergone biliary drainage prior to the initial chemotherapy. Liver/ lymph node/lung/peritoneum/bone metastases were present in 22/19/10/9/1 patients, respectively. The number of metastatic sites was 1/2/3 in 28/15/1 patients, respectively. The first-line chemotherapy regimens were GEM/GEM + S-1/S-1/GEM + Erlotinib/others in 28/10/2/1/3 patients, respectively. Second-line chemotherapy was performed in 28 patients (64%).The objective response rate to the first-line chemotherapy was 41%, and the disease control rate was 98%. The median overall survival was 23.4 months, and the median progression-free survival was 12.2 months. A multivariate analysis using the Cox proportional hazard model showed age (<70 years), sex (female), and WBC (<6000/&mgr;L) to be independent predictors of a longer survival. Conclusions: This retrospective analysis demonstrated that many long-term survivors have an objective tumor response to the first-line chemotherapy and live for almost a year, even after the failure of initial chemotherapy. Age (<70 years), sex (female), and WBC (<6000/&mgr;L) were predictors of a longer survival in this population.