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Recent treatment patterns and survival outcomes in pancreatic cancer according to clinical stage based on single-center large-cohort data.

ABSTRACT: Backgrounds/Aims:We performed a retrospective, single-center cohort study to evaluate the impact of various treatment modalities and recent changes in treatment modalities, including the increased application of chemotherapy, on survival in patients with pancreatic cancer. Methods:All patients with pancreatic cancer who were diagnosed and treated at Seoul National University Hospital between January 2007 and December 2014 were registered in a prospective clinical database and included in this retrospective study. All patients' radiologic imaging diagnoses were re-reviewed according to the National Cancer Center Network guidelines. The patients were divided into four groups according to their clinical stage, and each clinical stage group was further divided into four groups according to treatment modality. Results:Overall, 475 (28.9%) patients had resectable pancreatic cancer, 129 (7.8%) patients borderline resectable pancreatic cancer, 384 (23.3%) patients locally advanced pancreatic cancer, and 658 (40.0%) patients metastatic pancreatic cancer. Among the patients with borderline resectable pancreatic cancer, the median survival was significantly longer in the neoadjuvant therapy (NAT)+surgery groups (24 months) than the surgery without NAT (16 months) group (p=0.049). A multivariate survival analysis revealed that compared with the surgery group, the 5-year mortality risk was decreased by 35% in the NAT+surgery group (24 vs. 20 months, p=0.045). Conclusions:This retrospective cohort study showed that the rates of resectable and surgically treatable pancreatic cancer were 29.1% and 32.2%, which are higher than those reported previously, and aggressive NAT for select advanced-stage patients could lead to better survival outcomes.

SUBMITTER: Lee DH

PROVIDER: S-EPMC6295381 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Recent treatment patterns and survival outcomes in pancreatic cancer according to clinical stage based on single-center large-cohort data.

Lee Doo-Ho DH Jang Jin-Young JY Kang Jae Seung JS Kim Jae Ri JR Han Youngmin Y Kim Eunjung E Kwon Wooil W Kim Sun-Whe SW

Annals of hepato-biliary-pancreatic surgery 20181127 4

<h4>Backgrounds/aims</h4>We performed a retrospective, single-center cohort study to evaluate the impact of various treatment modalities and recent changes in treatment modalities, including the increased application of chemotherapy, on survival in patients with pancreatic cancer.<h4>Methods</h4>All patients with pancreatic cancer who were diagnosed and treated at Seoul National University Hospital between January 2007 and December 2014 were registered in a prospective clinical database and incl ...[more]

PMID: 30588531

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Project description:Pancreatic cancer is a highly malignant tumor in the digestive tract, with its incidence increasing year by year. Due to the insidious onset and rapid progression, most patients have already advanced disease at the time of the initial diagnosis, and the overall 5-year survival rate was only 11%. Tumors in T4 stage often have the invasion of key upperabdominal vessels, mainly referring to artery-involved pancreatic cancer with a worse prognosis. Resection of pancreatic ductal adenocarcinoma (PDAC) with T4 stage is more challenging and usually needs advanced surgical techniques including treatment of the involved artery including sub-adventitial divestment technique (SDT) and arterial resection with reconstruction, and periarterial dissection such as the Heidelberg Triangle Operation. SDT means a technique to separate the tumor from the artery by dissecting into the plane between the external elastic lamina (EEL) and the tunic media when the tumor was not invaded to EEL of the involved artery. Our previous study revealed that SDT procedure appears to be relatively safe, without excessive mortality, as compared to arterial resection with reconstruction. However, survival times can vary widely among different patients. So a strategy to select the T4 patients who may benefit from the surgery with SDT procedure is urgently needed. Our previous RNA-seq dataset has identified a series of differentially expressed circRNAs including circNEIL3 and circRHOBTB3 in PDACs. These results suggested that circRNAs might be prominent prognostic markers for PDAC. So to explore the prognostic value of circRNAs in pancreatic cancer and seek a useful biomarker for distinguishing specified population with a good prognosis from the whole T4 patients, we further performed whole transcriptome sequencing including miRNAs, mRNAs, lncRNAs and circRNAs in ten PDAC cancer samples with T4 stage but diametrically opposing survival outcomes. They all underwent radical surgery and received the assessments of pre- and post-operative contrast-enhanced computed tomography, five of these patients developed newly discovered metastasis soon after surgery and died within 4-9 months. In contrast, the other five patients had no recurrence or metastasis and had long-term survival for more than 39 months. We systematically identified differentially expressed circRNAs in our previous dataset and in patients with T4 stage through combining three popular circRNAs detection algorithms (CIRI2 v2.0.6, CIRCexplorer2 v2.3.8, and find_circ v1.2) and two differential analysis methods (DEGseq and DEseq). Results were validated by using quantitative RT-PCR. circRNA alternative splicing events and highly expressed circRNAs with high circular ratio were also identified by CircSplice and CIRCexplorer3-CLEAR pipeline.

Project description:BackgroundThe burden of non-small cell lung cancer (NSCLC) remains high in Spain, with lung cancer accounting for 20% of cancer-related deaths annually. Programs such as the Spanish Thoracic Tumour Registry (TTR) and the global I-O Optimise initiative have been developed to observe patients in clinical practice with the aim of improving outcomes. This analysis examined treatment patterns and survival in patients with stage III NSCLC from the TTR. These patients represent a heterogenous group with complex treatment pathways.MethodsThe TTR is an ongoing, observational, prospective, and retrospective cohort multicentre study (NCT02941458) that follows patients with thoracic cancer in Spain. Adults aged ≥18 years with stage IIIA/IIIB NSCLC enrolled in the TTR between 01 Jan 2010 and 31 Oct 2019 were included in this analysis. Initial treatment received was described by cancer stage and histology (squamous and non-squamous NSCLC). Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) were calculated over a 5-year period.ResultsA total of 1,838 patients were included in the cohort, including 1,082 with stage IIIA (58.9%) and 756 with stage IIIB (41.1%). Median follow-up was 18.3 months. The median age of patients was 66 years, and most had non-squamous NSCLC (54.0%), were male (81.2%), and were active or former smokers (93.4%). Overall, 26.3% of patients received surgical resection (37.0% for stage IIIA and 11.1% for stage IIIB). The most frequent initial treatment received was concurrent chemoradiotherapy for stage IIIA (30.2%) and stage IIIB (37.0%) patients. Median OS was lower in patients with stage IIIB than stage IIIA (28 vs. 37 months) disease and was lower for patients with squamous than non-squamous histology (19 vs. 26 months). Median PFS and OS varied when patients were stratified by initial treatment.ConclusionsThis TTR analysis describes the clinical reality surrounding the initial management and survival outcomes for stage III NSCLC in Spain and presents survival outcomes comparable with other real-world evidence. It provides insights into the diverse approaches used before the availability of immunotherapies and targeted treatments in the non-metastatic NSCLC setting.

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Recent treatment patterns and survival outcomes in pancreatic cancer according to clinical stage based on single-center large-cohort data.

Publications

Recent treatment patterns and survival outcomes in pancreatic cancer according to clinical stage based on single-center large-cohort data.

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