Clinical Impact of Local Progression in Pancreatic Cancer

Abstract

The high prevalence of distant metastatic disease among patients with pancreatic cancer often draws attention away from the local pancreatic tumor. This study aimed to define the complications and hospitalizations from local versus distant disease progression among a retrospective cohort of patients with pancreatic cancer. Records of 298 cases of pancreatic cancer treated at a single institution from 2004 through 2015 were retrospectively reviewed, and cancer-related symptoms and complications requiring hospitalization were recorded. Hospitalizations related to pancreatic cancer were attributed to either local or distant progression. Cumulative incidence analyses were used to estimate the incidence of hospitalization, and multivariable Fine-Gray regression models were used to identify factors predictive of hospitalizations. The 1-year cumulative incidences of hospitalization due to local versus distant disease progression were 31% and 24%, respectively. Among 509 recorded hospitalizations, leading local etiologies included cholangitis (10%), biliary obstruction (7%), local procedure complication (7%), and gastrointestinal bleeding (7%). On multivariable analysis, significant predictors of hospitalization from local progression included unresectable disease (subdistribution hazard ratio [SDHR], 2.42; <.01), black race (SDHR, 3.34; <.01), younger age (SDHR, 1.02 per year; =.01), tumor in the pancreatic head (SDHR, 2.19;<.01), and larger tumor size (SDHR, 1.13 per centimeter; =.02). Most patients who died in the hospital from pancreatic cancer (56%) were admitted for complications of local disease progression. Patients with pancreatic cancer experience significant complications of local tumor progression. Although distant metastatic progression represents a hallmark of pancreatic cancer, future research should also focus on improving local therapies.

P2RY12-Inhibitors Reduce Cancer-Associated Thrombosis and Tumor Growth in Pancreatic Cancers

“…In contrast, when we analyzed the thrombotic profile at day 25 after tumor implantation (Panc02 mice D25), they seem to have phenotypically changed to a pro-hemorrhagic state evidenced by the diminution of platelet and fibrin accumulation at the site of injury compared to both the Panc02 mice D10 and control ( Figure 2A ). These results are in accordance with the clinical data showing that advanced-stage cancer patients may have bleeding complications, which are mainly associated to disseminated intravascular coagulopathy ( 38 – 40 ).…”

“…These spontaneous aggregates were inhibited after treatment with clopidogrel ( Figure 2B , right panel). To our knowledge these spontaneous thrombi have not been described in literature yet, and reflect the clinical manifestations of cancer-associated thrombosis ( 38 – 40 ).…”

Upfront Chemotherapy Followed by Stereotactic Body Radiation Therapy with or without Surgery in Older Patients with Localized Pancreatic Cancer: A Single Institution Experience and Review of the Literature

“…Unfortunately, some older patients are unfit for surgical resection or aggressive systemic therapy. These patients may be at risk of uncontrolled tumor growth, which can cause significant local morbidity such as cholangitis, biliary obstruction, GI bleeding, and celiac plexopathy, which in turn, can drive both morbidity and mortality [ 24 ]. In fact, the median OS for untreated pancreatic cancer is just 2.5 months [ 25 ].…”

Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions

“…Local progression causes morbidity, which is difficult to treat. Effective local therapies can reduce symptoms and improve quality of life, both of which RT has been consistently shown to effectively accomplish ( 19 , 20 ).…”