Improvement of long-term outcomes in pancreatic cancer and its associated factors within the gemcitabine era: a collaborative retrospective multicenter clinical review of 1,082 patients

Abstract

BackgroundAlthough the outcomes of pancreatic cancer have been improved by gemcitabine, the changes in its characteristics and long-term outcomes within the gemcitabine era remain unclear. This study was conducted to identify clinical characteristics of pancreatic cancer patients within the gemcitabine era.MethodsA retrospective chart review was performed at 10 centers for 1,248 consecutive patients who were ever considered to have a diagnosis of pancreatic cancer between 2001 and 2010. Data collected included demographics, diagnosis date, clinical stage, treatment, and outcome; 1,082 patients met the inclusion criteria and were analyzed further. The chi-square test, Student’s t-test, and Mann–Whitney U-test were used for statistical analysis. Outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Differences in survival analyses were determined using the log-rank test.ResultsThe distribution of clinical stages was: I, 2.2%; II, 3.4%; III, 13%; IVa, 27%; and IVb, 55%. Chemotherapy alone was administered to 42% of patients and 17% underwent resection. The 1-, 3-, and 5-year survival rates were 39%, 13%, and 6.9%, respectively. The median survival time was 257 days, but differed considerably among treatments and clinical stages. Demographics, distribution of clinical stage, and cause of death did not differ between groups A (2001–2005, n = 406) and B (2006–2010, n = 676). However, group B included more patients who underwent chemotherapy (P < 0.0001) and fewer treated with best supportive care (P = 0.0004), mirroring improvements in this group’s long-term outcomes (P = 0.0063). Finally, factors associated with long-term outcomes derived from multivariate analysis were clinical stage (P < 0.0001), location of the tumor (P = 0.0294) and treatments (surgery, chemotherapy) (P < 0.0001).ConclusionsLong-term outcomes in pancreatic cancer has improved even within the gemcitabine era, suggesting the importance of offering chemotherapy to patients previously only considered for best supportive care. Most patients are still diagnosed at an advanced stage, making clinical strategy development for diagnosing pancreatic cancer at earlier stages essential.

Early Detection of Pancreatic Cancer in Patients With Chronic Liver Disease Under Hepatocellular Carcinoma Surveillance

“…The diagnosis of PC was based on tumor markers, abdominal imaging, or histologic findings, as previously described. 7 The present study examined data regarding age, sex, likelihood of PC diagnosis, UICC stage (7th edition) 15 at PC diagnosis, and markers for viral hepatitis (hepatitis B surface antigen and antibodies to HCV). The staging of PC was generally based on the clinical stage, although the classification of stage 0 was determined pathologically.…”

“…Furthermore, PC has an invasive behavior, 6 which makes it difficult to diagnose at an early stage. Thus, more than one half of the patients with PC have distant metastasis at their diagnosis, and as few as 20% of patients with newly diagnosed PC are eligible for surgical resection, 7 which is the only potentially curative treatment. Therefore, it is ideal that the patients are diagnosed by Union for International Cancer Control (UICC) stage IIA (without lymph node and distant metastasis).…”

Silencing of RUNX2 enhances gemcitabine sensitivity of p53-deficient human pancreatic cancer AsPC-1 cells through the stimulation of TAp63-mediated cell death

“…Human pancreatic cancer is a highly aggressive, as well as metastatic tumor, and represents the fourth and fifth leading causes of cancer-related death in the United States and Japan, respectively, whose incidence is increasing. 1 , 2 Although the best chance of long-term survival is the complete surgical resection, most patients (over 80%) are not amenable to surgery at the time of diagnosis because of its difficulty in early detection. 3 Unfortunately, even in patients who underwent surgery, a high rate of relapse with high local recurrence rates up to 50% is detectable, which leads to a 5-year survival rate of under 5%.…”

Silencing of RUNX2 enhances gemcitabine sensitivity of p53-deficient human pancreatic cancer AsPC-1 cells through the stimulation of TAp63-mediated cell death

“…It has been well-known that human pancreatic cancer represents the fourth and fifth leading causes of cancer-related deaths in the United States and Japan, respectively. 1 , 2 Notably, pancreatic cancer is characterized by high metastatic potential, resistance to chemotherapy and thus its prognosis is extremely poor with 5-year survival <5%. At diagnosis, more than 80% cases are already advanced and non-resectable.…”