Abstract
411 Background: Natural history (NHx) and overall survival (OS) of patients (pts) with LPC and PPC without gross metastasis (GM) at initial diagnosis are rarely studied. We assessed rate, time and pattern of disease recurrence (REC), impact of local therapy (Rx) and OS in this pt cohort from our institution. Methods: The Virginia Mason Pancreatic Cancer (PC) Database (Picozzi et.al. Proc GI Cancer Symp 2011) was used to identify pt cohort. Inclusion criteria were 1) laparoscopic PPC and 2) no other evidence of GM (radiographic/ laparoscopic). Local progression (LP) was defined as primary tumor growth with change/cessation of chemoRx. Systemic progression (SP) was defined as radiological/pathological metastastic progression. The database provided OS. Results: 39/884 (4.4%) pts initiating Rx at VMMC from 2003-2014 met these criteria. 13/39 pts were included in a prior report (Clark et.al. Am J Surg 2010). Pt characteristics include: 21/39 (54%) male; median (med) age 65 (range 49 – 83) yrs; 25/39 (64%) head lesions; med tumor size 39 (range 25 - 100) mm. Med pt follow-up is 13 mo. All pts received gemcitabine-combination chemoRx as initial Rx. 14/39 (36%) pts also received local Rx (13 consolidative chemoXRT, 1 surgery). 3 month (mo) disease control (DC) was 86% (31/36 pts, 3 pts followed <3 mo). 6 mo progression - free survival (PFS) was 72% (26/36 pts). 6/36 pts (16%, range 9+-15+ mo) are progression – free. 30/36 pts (83%) progressed (med time 8.1 mo). REC pattern was local (13/30 pts, 43%), distant (9/30 pts, 30%) and combined (8/30 pts, 27%). Pts given local Rx did not differ statistically from pts given systemic Rx only with respect to 3 mo DC, 6 mo PFS, REC rate, time, or pattern, or OS. OS for LPC with PPC was significantly better than pts with GM (n = 277) identified from the database from 2003-2014 (med OS 15 vs. 9.3 mo, p = 0.0002; 1-yr OS 68 vs. 32%, p = 0.01; 2-yr OS 34 vs. 12%, p = 0.007). Conclusions: 1)LPC with PPC is a rare PC pt cohort with high response rates to chemoRx and superior OS to those with GM. 2) However, long-term disease free OS was not seen. 3)Local Rx did not clearly alter pt cohort NHx. 4)This is the largest pt series of this pt cohort compiled from a US institution; their further study seems of value.
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