Abstract
Purpose: To evaluate the overall survival of patients with oligometastatic pancreatic ductal adenocarcinoma (PDAC; metastatic tumor <4 cm, ≤2 metastatic tumors total) receiving neoadjuvant therapy, metastasectomy and/or ablation, and primary tumor resection.Methods: We performed a case–control study from January 2005 to December 2015. Patients who underwent curative-intent surgery combined modality therapy (M1 surgery group; 6 [14%], tumor [T]3, node [N]1, and oligo-metastases [M]1) were matched 1 to 3 based on TN stage with two control groups (M0 surgery and M1 no surgery). The M0 surgery group (18 [43%], T3, N1, and M0) included patients without metastases who underwent resection. The M1 no surgery group (18 [43%], T3, N1, and M1) included patients with metastatic PDAC who received palliative chemotherapy without surgical resection.Results: Median overall survival in the M1 surgery, M0 surgery, and M1 no surgery groups was 2.7 years (95% confidence interval [CI], 0.71–3.69), 2.02 years (95% CI, 0.98–3.05), and 0.98 years (95% CI, 0.55–1.25), respectively. Eastern Cooperative Oncology Group (ECOG) status was associated with survival (p = 0.01) after univariate analysis. After adjusting for ECOG status, multivariate analysis showed M1 surgery patients had improved survival compared with M1 no surgery patients and similar survival to M0 surgery patients.Conclusion: Multimodal therapy benefitted our M1 surgery patients. A larger, prospective study of this multidisciplinary management strategy is currently under way.
Highlights
Pancreatic cancer is the third leading cause of cancerrelated death in United States, and it is anticipated to be the second most common cause by 2020.1,2 The 5-year median survival is 8%.3 Even though the cancerrelated deaths associated with most cancers have declined over the past decade, the rate of death associated with pancreatic cancer has shown only slight improvement in overall survival.[3,4] The shorter survival period and poorer outcomes may be due to the aggressive nature of this cancer, its late-stage presentation, and its tendency to develop early metastases
Of this 42 patients were included in this study, and 6 (14%) in M1 surgery group were matched for tumor resectability and TN stage with 18 (42%) in the M0 surgery group and 18 (42%) in the M1 no surgery group
Surgical technique and outcomes following surgical resection has evolved over the years,[19] but controversy exists surrounding the concept of metastasectomy in the management of metastatic pancreas cancer
Summary
Pancreatic cancer is the third leading cause of cancerrelated death in United States, and it is anticipated to be the second most common cause by 2020.1,2 The 5-year median survival is 8%.3 Even though the cancerrelated deaths associated with most cancers have declined over the past decade, the rate of death associated with pancreatic cancer has shown only slight improvement in overall survival.[3,4] The shorter survival period and poorer outcomes may be due to the aggressive nature of this cancer, its late-stage presentation, and its tendency to develop early metastases. Pancreatic cancer is the third leading cause of cancerrelated death in United States, and it is anticipated to be the second most common cause by 2020.1,2 The 5-year median survival is 8%.3. Even though the cancerrelated deaths associated with most cancers have declined over the past decade, the rate of death associated with pancreatic cancer has shown only slight improvement in overall survival.[3,4] The shorter survival period and poorer outcomes may be due to the aggressive nature of this cancer, its late-stage presentation, and its tendency to develop early metastases. Surgery is one of the treatment options for pancreatic ductal adenocarcinoma (PDAC); only 15–20% of patients are eligible for curative intent surgery at the time of diagnosis.[5,6,7,8].
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