Correlation of tumor size and survival in pancreatic cancer

Abstract

Background: Neoadjuvant therapy (NT) for resectable pancreatic adenocarcinoma (PAC) continues to be debated. We sought to establish the relationship between pancreatic tumor size, neoadjuvant chemotherapy (NCT), neoadjuvant chemoradiation (NCRT), and definitive surgery (DS) on survival.Methods: Utilizing the National Cancer Database we identified patients with PAC who underwent NT and DS. Patient characteristics and survival were compared with Mann-Whitney U, Pearson's Chi-square, and the Kaplan-Meier method. Multivariable analysis (MVA) was developed to identify predictors of survival. All tests were two-sided and α <0.05 was significant. Results: We identified 11,707 patients: 9,722 patients with tumors >2 cm and 1,985 with tumors ≤2 cm.There were 523 patients treated with NCT, 559 treated with NCRT, and 10,625 DS. Patients with tumors >2 cm were more likely to have higher T-stage, P<0.001, positive lymph nodes, P<0.001, poor histologic grade, P<0.001, and R1 resections, P<0.001. The median survival for patients with tumors ≤2 cm was 30.6 months compared to 20.5 months for those whose tumors were >2 cm, P<0.001. In the >2 cm groups the median survival for NCT, NCRT, and DS was 22.9, 25.8 and 21.3 months, P=0.01. MVA revealed that age, Charlson/Deyo score, N-stage, grade, tumor size >2 cm, R0 resection, and NT were predictors of survival. Ninety-day mortality was worse in both the NCT and NCRT compared to DS, P<0.001. Conclusions: The size of pancreatic cancer correlates to pathologic stage and overall survival. Tumors >2 and <2 cm benefited from a NT. However, the 90-operative mortality was significantly worse in those patients receiving NT.

Predicting Selection Preference of Robotic Pancreaticoduodenectomy (RPD) in a Chinese Single Center Population: Development and Assessment of a New Predictive Nomogram

“…For tumor biomarkers, CEA was used for selection for RPD instead of CA 19-9. Some studies considered that the independent risk predictors of postoperative serum CA19-9, CA125, and CEA indicated poor surgical outcome in pancreatic ductal adenocarcinoma [34]. CA 19-9 is a good indicator for the screening of pancreatic cancer [35] but was not a good predictor of selection for RPD in our study.…”

Lymph Node Metastatic Patterns and Survival Predictors Based on Tumor Size in Pancreatic Ductal Adenocarcinoma

“…In our study, a tumor size of 40 mm is the potential demarcation point for the prevalence of LN metastases, the probability of metastasis in each regional LN and N2/N1 ratio in node-positive patients. Takahashi C et al [25] determined that a tumor size of 20 mm as the ideal cut-off and found that patients with tumors > 20 mm were more likely to have positive LNs. This was consistent with our ndings that the prevalence of LN metastases, the probability of metastasis in each regional LN and the N2/N1 ratio in node-positive patients for tumor size more than 20 mm were all absolutely higher than tumors < 20 mm.…”

The GALNT14 Genotype Predicts Postoperative Outcome of Pancreatic Ductal Adenocarcinoma

“…The insignificant result in the Cox model might be attributed to the inadequate patient numbers. Previous studies discovered that either short-term surgical outcome or postoperative long-term survival differs dramatically between patients with tumors more than and less than 2 cm in size [37][38][39]. Our study recorded the cut-off of tumor size in three dimensions (10 cm 3 ).…”