Poor Prognostic Factors in Long-Term Survivors of Resected Pancreatic Ductal Adenocarcinoma: An International, Multicenter Cohort Study

Ammar A Javed; Ingmar F Rompen; Iris W J M van Goor; Thomas F Stoop; Paul Andel; Omar Mahmud; Asad Saulat Fatimi; Joseph R Habib; Nabiha A Mughal; Thijs Schouten; Kelly Lafaro; Richard A Burkhart; William R Burns; Hjalmar C van Santvoort; Marcel den Dulk; Freek Daams; J Sven D Mieog; Martijn W J Stommel; Gijs A Patijn; Ignace de Hingh; Sebastiaan Festen; Maarten W Nijkamp; Joost M Klaase; Daan J Lips; Jan H Wijsman; Erwin van der Harst; Eric Manusama; Casper H J van Eijck; Bas Groot Koerkamp; Geert Kazemier; Olivier R Busch; I Quintus Molenaar; Lois A Daamen; Jin He; Christopher L Wolfgang; Marc G Besselink; Dutch Pancreatic Cancer Group and the PANC-PALS Consortium

doi:10.1097/SLA.0000000000006539

Poor Prognostic Factors in Long-Term Survivors of Resected Pancreatic Ductal Adenocarcinoma: An International, Multicenter Cohort Study

Ann Surg. 2024 Sep 17. doi: 10.1097/SLA.0000000000006539. Online ahead of print.

Authors

Ammar A Javed^{1

2

3}, Ingmar F Rompen^{1

4}, Iris W J M van Goor⁵, Thomas F Stoop^{2

3}, Paul Andel⁵, Omar Mahmud^{1

6}, Asad Saulat Fatimi^{1

6}, Joseph R Habib¹, Nabiha A Mughal¹, Thijs Schouten⁵, Kelly Lafaro⁷, Richard A Burkhart⁷, William R Burns⁷, Hjalmar C van Santvoort⁸, Marcel den Dulk^{9

10}, Freek Daams^{2

3}, J Sven D Mieog¹¹, Martijn W J Stommel¹², Gijs A Patijn¹³, Ignace de Hingh¹⁴, Sebastiaan Festen¹⁵, Maarten W Nijkamp¹⁶, Joost M Klaase¹⁶, Daan J Lips¹⁷, Jan H Wijsman¹⁸, Erwin van der Harst¹⁹, Eric Manusama²⁰, Casper H J van Eijck²¹, Bas Groot Koerkamp²¹, Geert Kazemier²², Olivier R Busch^{2

3}, I Quintus Molenaar⁵, Lois A Daamen⁵, Jin He⁷, Christopher L Wolfgang¹, Marc G Besselink^{2

3}; Dutch Pancreatic Cancer Group and the PANC-PALS Consortium

Affiliations

¹ Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
² Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.
³ Cancer Center Amsterdam, the Netherlands.
⁴ Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
⁵ Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands.
⁶ Medical College, Aga Khan University, Karachi, Pakistan.
⁷ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
⁹ Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁰ Nutrim School for Nutrition and Translational Research in Metabolism, Maastricht.
¹¹ Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
¹² Department of Surgery, Radboudumc, Nijmegen, the Netherlands.
¹³ Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
¹⁴ Deaprtment of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
¹⁵ Department of Surgery, OLVG, Amsterdam, the Netherlands.
¹⁶ Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
¹⁷ Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
¹⁸ Department of Surgery, Amphia Hospital, Breda, The Netherlands.
¹⁹ Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
²⁰ Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
²¹ Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
²² Department of Surgery, Amsterdam University Medical Center (UMC), Vrije Universiteit, Amsterdam, the Netherlands.

PMID: 39286904
DOI: 10.1097/SLA.0000000000006539

Abstract

Objective: To measure the rate of LTS in resected PDAC and determine the association between predictors of OS and LTS.

Summary background data: Long-term survival (>5 y, LTS) remains rare in pancreatic ductal adenocarcinoma (PDAC). Multiple predictors of overall survival (OS) are known but their association with LTS remains unclear.

Methods: An international, multicenter retrospective study was conducted. Included were patients from 2012-2019 with resected PDAC. Excluded were those with metastases at diagnosis or resection, R2 resections, and 90-day mortality. Predictors of OS were identified using multivariable Cox regression and their prevalence in patients with LTS assessed. LTS was calculated by excluding patients with shorter follow-up and predictors of LTS were identified using multivariable logistic regression.

Results: 3,003 patients were included (27.4% received neoadjuvant chemotherapy). Elevated baseline CA19-9, high tumor grade, nodal disease, and perineural and lymphovascular invasion were negative independent predictors of OS, while receipt of adjuvant chemotherapy predicted improved OS (all P<0.05). LTS was observed in 220/2,436 patients (9.0%), of whom 198 (90%) harbored poor prognostic factors: elevated baseline CA19-9 (58.1%), poor tumor differentiation (51.0%), nodal disease (46.8%), and perineural invasion (76.0%). Of those without any of these four features, 50.0% achieved LTS as compared to 21.3%, 13.3%, 5.2%, and 3.5% in those with 1, 2, 3, or 4 features.

Conclusions: This bi-national cohort demonstrates a true LTS rate of 9.0% in resected PDAC. Clinicians should remain aware that presence of poor prognostic factors does not preclude LTS.