Resected pancreatic adenocarcinoma: An Asian institution's experience

Abstract

Background: Pancreatic adenocarcinoma (PDAC) is highly lethal. Surgery offers the only chance of cure, but 5-year overall survival (OS) after surgical resection and adjuvant therapy remains dismal. Adjuvant trials were mostly conducted in the West enrolling fit patients. Applicability to a general population, especially Asia has not been described adequately.Aim: We aimed to evaluate the clinical outcomes, prognostic factors of survival, pattern, and timing of recurrence after curative resection in an Asian institution. Methods and Results:The clinicopathologic and survival outcomes of 165 PDAC patients who underwent curative resection between 1998 and 2013 were reviewed retrospectively. Median age at surgery was 62.0 years. 55.2% were male, and 73.3% had tumors involving the head of pancreas. The median OS of the entire cohort was 19.7 months. Median OS of patients who received adjuvant chemotherapy was 23.8 months. Negative predictors of survival include lymph node ratio (LNR) of >0.3 (HR = 3.36, P = .001), tumor site involving the body or tail of pancreas (HR = 1.59, P = .046), presence of perineural invasion (PNI) (HR = 2.36, P = .018) and poorly differentiated/undifferentiated tumor grade (HR = 1.86, P = .058). The median time to recurrence was 8.87 months, with 66.1% and 81.2% of patients developing recurrence at 12 months and 24 months respectively. The most common site of recurrence was the liver. Conclusion:The survival of Asian patients with resected PDAC who received adjuvant chemotherapy is comparable to reported randomized trials. Clinical characteristics seem similar to Western patients. Hence, geographical locations may not be a necessary stratification factor in RCTs. Conversely, lymph node ratio and status of PNI ought to be incorporated.

Prognostication for recurrence patterns after curative resection for pancreatic ductal adenocarcinoma

“…They could explain the difference in recurrence patterns from other studies. The recurrence rate within the first year after surgery was 48% (n = 44), decreasing to 21% (n = 19) in the second year and 3% (n = 3) in the third year, consistent with other studies demonstrating a high rate of recurrence within the first year (40%-61%) [9,20,21] possibly due to undiagnosed micro-metastases at the time of surgery [22]. These sub-clinical micro-metastases could then be classified as postoperative recurrence within a short postoperative timeframe [8,23].…”

Analysis of Risk Factors for Distant Metastasis of Pancreatic Ductal Adenocarcinoma without Regional Lymph Node Metastasis and a Nomogram Prediction Model for Survival

“…For example, Brennan et al [ 31 ] and Lau et al [ 27 ] reported that patients with tumors located in the pancreatic head were more prone to distant metastasis, which was associated with a poor prognosis. In contrast, studies by Watanabe et al, Artinyan et al, [ 28 , 29 ], and Ng et al [ 32 ] reported that patients with tumors located in the pancreatic body/tail were more likely to have distant metastasis at the time of treatment and therefore had poor overall survival (OS). The results of our study showed that in PDAC with N 0 patients, the risk of distant metastasis for tumors in the pancreatic body/tail is higher, and specifically, the risk of developing distant metastasis is 2–2.5 times higher in the pancreatic tail (OR = 4.78, 95% CI 3.71–6.19) than in other sites.…”

RIOK3 promotes mTORC1 activation by facilitating SLC7A2-mediated arginine uptake in pancreatic ductal adenocarcinoma

“…Currently, the overall 5-year survival rate for PDAC is only about 7%, and it is estimated that by 2030, PDAC deaths will be the 2nd leading cause of tumor-related death in the United States after non-small cell lung cancer [3]. Surgical resection is the only effective treatment for PDAC, and chemotherapy remains the first choice for patients with unresectable PDAC [4]. However, multiple treatments such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy have not significantly improved the long-term survival rate of PDAC patients [5][6][7].…”