Does long-term survival exist in pancreatic adenocarcinoma?

Zijlstra, Myrte; Bernards, Nienke; Hingh, Ignace H. J. T. de; Wouw, Agnès J. van de; Goey, S.H.; Jacobs, Esther; Lemmens, Valery; Creemers, Geert-Jan

doi:10.3109/0284186x.2015.1096020

Cited by 25 publications

(22 citation statements)

References 23 publications

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“…A rather large proportion of low stage tumors in this group most likely explains this. Furthermore, among this group, a large proportion concerned a pathologically unverified tumor (76%), what may have led to longer survival due to misclassification [35]. In addition, older patients receiving tumor targeting treatment seem to have similar survival benefit as younger patients.…”

Section: Discussionmentioning

confidence: 99%

Patient characteristics and treatment considerations in pancreatic cancer: a population based study in the Netherlands

et al. 2018

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Background: Pancreatic cancer carries a poor prognosis. To date, there has been little research devoted to decision-making regarding treatment options in pancreatic cancer, including the rationale for choosing to withhold tumor targeting treatment (TTT). This study aims to gain insight into the characteristics of patients receiving no TTT, the reasons for this decision and their survival. Methods: All patients diagnosed in the Netherlands between 1 January 2014 and 30 June 2015 with a proven pancreatic adenocarcinoma or a pathologically unverified pancreatic tumor were identified in the Netherlands Cancer Registry. Information on initial management, patient characteristics, main reasons for no TTT (as reported in medical charts) and survival were analyzed. Results: A total of 3090 patients was included. Of these patients, 1818 (59%) received no TTT. Median age of no TTT patients was 74 years (range 35-99) versus 66 years (30-87) for TTT patients. In the no TTT group 77% had a clinical stage III/IV versus 57% of patients who received TTT. Main reasons for not starting TTT were patient's choice (27%) and extensive disease (21%). Median survival of patients who did not receive TTT was 1.9 months, ranging from a median survival of 0.8 months (when main reason to withhold TTT was short life expectancy) to 4.4 months (main reason to withhold TTT: old age). In the latter group, a relatively large proportion of clinical stage I tumors was present (37%). Conclusion: The majority of patients with pancreatic cancer received no TTT and had a very poor median survival. In most patients, patient's choice not to start treatment was the main reason for withholding treatment, suggesting patient's involvement in decision-making.

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Section: Discussionmentioning

confidence: 99%

Patient characteristics and treatment considerations in pancreatic cancer: a population based study in the Netherlands

et al. 2018

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“…Therefore, chemotherapy use and survival of elderly NR‐M0 patients may be slightly overestimated in our study, while early mortality may be underestimated. Survival may also be slightly overestimated because some patients of the large group without histological confirmation of pancreatic cancer were incorrectly diagnosed . Despite these limitations, the available unselected data of an often neglected group of pancreatic cancer patients revealed important findings about trends in everyday clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Survival may also be slightly overestimated because some patients of the large group without histological confirmation of pancreatic cancer were incorrectly diagnosed. 24 Despite these limitations, the available unselected data of an often neglected group of pancreatic cancer patients revealed important findings about trends in everyday clinical practice. Secondly, survival trends of NR-M0 patients in the course of the study period must be interpreted with caution as a result of changing characteristics of this subgroup and possible residual 4950 | van der GeeST eT al.…”

Section: Discussionmentioning

confidence: 99%

Trends in treatment and survival of patients with nonresected, nonmetastatic pancreatic cancer: A population‐based study

et al. 2018

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BackgroundNonresected, nonmetastatic (NR‐M0) pancreatic cancer involves both locally advanced pancreatic cancer and patients who did not undergo resection due to poor health status or patient preference. This study investigates nationwide trends of characteristics, treatment, and survival of patients with NR‐M0 pancreatic cancer.MethodsFrom the Netherlands Cancer Registry, all patients diagnosed with pancreatic cancer between 2006 and 2014 were selected. Chemotherapy and overall survival (OS) of NR‐M0 patients were evaluated for 3‐year time periods and 2 age groups using chi‐square tests for trend and Cox proportional hazard regression analysis.ResultsOf 18 234 patients, 33% had NR‐M0 pancreatic cancer, which decreased over time (in consecutive 3‐year periods: 38%‐33%‐28%, P < 0.001). Of 5964 NR‐M0 patients, 52% was over 75 years of age, 16% received chemotherapy, and median OS was 5.1 months. Chemotherapy use increased over time in younger patients (<75 years: from 23 to 36%, P‐trend < 0.001, ≥75 years: 3% to 4%, P‐trend = 0.053). In multivariable survival analysis, elderly age, low SES, nonconfirmed cancer, stage II‐III disease, and earlier years of diagnosis were independently associated with a worse OS. Age of patients who received chemotherapy increased over time (median 62‐66 years) and median OS was 10.4 months without significant differences between time periods (P = 0.177) or age groups (P = 0.207).ConclusionsOverall survival of NR‐M0 pancreatic cancer remains poor which is partly related to advanced age of many patients. Despite an increase, chemotherapy is infrequently used. Future research should investigate to what extent the more widespread use of chemotherapy could improve survival in relation to age‐related morbidity.

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“…A study performed in the United States based on data from Surveillance, Epidemiology, and End Results registry has shown that a pancreatectomy is associated with statistically significant increased survivals for patients with resectable PDAC (i.e., stage I/ II), compared with any other form of therapy (3). Furthermore, a recent study performed in the Netherlands has shown that the percentage of patients with PDAC who survived more than 5 years is significantly higher after resection (10.1%), compared with patients with unresected localized or metastatic disease (0.5% and 0.1%, respectively) (4). Median overall survival time after resection for PDAC is approximately two years (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

What is the Value of Total Mesopancreas Excision in Pancreatic Ductal Adenocarcinoma? Current Evidence of the Literature

Popescu¹,

Dumitraşcu²

2018

chr

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Pancreatic ductal adenocarcinoma (PDAC) is a disease with a grim prognosis. Pancreatectomy represents the single hope for long-term survival in a patient with PDAC. Recurrence is a common event after curative-intent surgery for PDAC, mainly related to incomplete removal at the site of resection margins; medial/ superior mesenteric margins are the most often positive. The concept of total mesopancreas excision (TMpE) in PDAC was proposed in analogy to the concept of total mesorectal excision for rectal cancer, to better control loco-regional recurrence. This paper aims to discuss the current evidence for the value of TMpE in PDAC.

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Does long-term survival exist in pancreatic adenocarcinoma?

Abstract: Background:We conducted a population-based study to investigate long-term survival in patients diagnosed with a (suspected) pancreatic adenocarcinoma.

Cited by 25 publications

References 23 publications

Patient characteristics and treatment considerations in pancreatic cancer: a population based study in the Netherlands

Patient characteristics and treatment considerations in pancreatic cancer: a population based study in the Netherlands

Trends in treatment and survival of patients with nonresected, nonmetastatic pancreatic cancer: A population‐based study

What is the Value of Total Mesopancreas Excision in Pancreatic Ductal Adenocarcinoma? Current Evidence of the Literature

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