Clinical and pathological features of five-year survivors after pancreatectomy for pancreatic adenocarcinoma.

Kenjiro Kimura,Kohei Nishio,Keiichiro Hirata,Sadaaki Yamazoe,Kotaro Miura,Toshiki Hirakawa,Kosei Hirakawa,Ryosuke Amano,Bunzo Nakata,Akihiro Murata,Masaichi Ohira

doi:10.1186/1477-7819-12-360

Abstract

BackgroundClinical factors determining short-term survival after pancreatectomy have been well studied, but factors predicting long-term survival with curative resection are poorly understood in pancreatic carcinoma. Our objective was to identify clinical and pathological features of five-year disease-free survivors after surgical resection of pancreatic adenocarcinoma.MethodsThe clinical and pathological data from 147 patients who underwent a potentially curative resection for pancreatic adenocarcinoma at our institution between 1988 and 2012 were retrospectively analyzed.ResultsOf 147 patients, 18 survived for more than five years after surgery without disease recurrence. A univariate analyses demonstrated that: two or fewer lymph node metastases (P = 0.014), a preoperative serum carbohydrate antigen 19-9 (CA19-9) level of 40 U/mL or less (P = 0.0018), an absence of intrapancreatic nerve invasion (P = 0.028), and undergoing an R0 resection (P = 0.011) were significantly associated with five-year survival. A logistic regression model identified the following independent cancer-related predictors of five-year survivors: having two or fewer lymph node metastases (odds ratio (OR): 6.02; 95% confidence interval (CI): 1.08 to 112.98; P = 0.0385), a preoperative serum CA19-9 level of 40 U/mL or less (OR: 5.02; 95% CI: 1.68 to 16.48; P = 0.0036), and undergoing an R0 resection (OR: 3.63; 95% CI: 1.12 to 14.28; P = 0.0316).ConclusionsWe conclude that number of lymph node metastases being two or less, a preoperative serum CA19-9 level of 40 U/mL or less, and undergoing an R0 resection may be independent predictive factors to identify actual five-year survivors after pancreatectomy for pancreatic adenocarcinoma.

Highlights

Clinical factors determining short-term survival after pancreatectomy have been well studied, but factors predicting long-term survival with curative resection are poorly understood in pancreatic carcinoma
In the many previous reports, the follow-up period was within five years, but precise data on the long-term survival and prognostic factors can be obtained by analysis of actuarial data, and of data of patients who achieve actual long-term survival of five years or more
Of the 195 patients, 48 patients were excluded for the following reasons: 42 censored cases, composed of four patients who were lost to follow-up during the observation period and 38 patients who were alive within five years after the operation; four due to postoperative mortality within 30 days; and two were five-year survivors with recurrence disease

Summary

Introduction

Clinical factors determining short-term survival after pancreatectomy have been well studied, but factors predicting long-term survival with curative resection are poorly understood in pancreatic carcinoma. Pancreatic carcinoma is the fourth leading cause of death from cancer and is responsible for 43,000 deaths per year in the United States [1]. The prevalence of pancreatic cancer in Japan has increased in the last decade to become the fifth leading cause of cancer death in men, and the sixth in women [2]. This malignancy is devastating, with a five-year overall survival rate of approximately 5% [1]. In the many previous reports, the follow-up period was within five years, but precise data on the long-term survival and prognostic factors can be obtained by analysis of actuarial data, and of data of patients who achieve actual long-term survival of five years or more

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