A population-based study of synchronous distant metastases and prognosis in patients with PDAC at initial diagnosis

Abstract

ObjectiveCancer of the pancreas is a life-threatening condition and has a high distant metastasis (DM) rate of over 50% at diagnosis. Therefore, this study aimed to determine whether patterns of distant metastases correlated with prognosis in pancreatic ductal adenocarcinoma (PDAC) with metastatic spread, and build a novel nomogram capable of predicting the 6, 12, 18-month survival rate with high accuracy.MethodsWe analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database for cases of PDAC with DM. Kaplan-Meier analysis, log-rank tests and Cox-regression proportional hazards model were used to assess the impact of site and number of DM on the cancer-specific survival (CSS) and over survival (OS). A total of 2709 patients with DM were randomly assigned to the training group and validation group in a 7:3 ratio. A nomogram was constructed by the dependent risk factors which were determined by multivariate Cox-regression analysis. An assessment of the discrimination and ability of the prediction model was made by measuring AUC, C-index, calibration curve and decision curve analysis (DCA). In addition, we collected 98 patients with distant metastases at the time of initial diagnosis from Ningbo University Affiliated LiHuili Hospital to verify the efficacy of the prediction model.ResultsThere was a highest incidence of liver metastases from pancreatic cancer (2387,74.36%), followed by lung (625,19.47%), bone (190,5.92%), and brain (8,0.25%). The prognosis of liver metastases differed from that of lung metastases, and the presence of multiple organ metastases was associated with poorer prognosis. According to univariate and multivariate Cox-regression analyses, seven factors (i.e., diagnosis age, tumor location, grade of tumor differentiation, T-stage, receipt of surgery, receipt of chemotherapy status, presence of multiple organ metastases) were included in our nomogram model. In internal and external validation, the ROC curves, C-index, calibration curves and DCA were calculated, which confirmed that this nomogram can precisely predict prognosis of PDAC with DM.ConclusionMetastatic PDAC patients with liver metastases tended to have a worse prognosis than those with lung metastases. The number of DM had significant effect on the overall survival rate of metastatic PDAC. This study had a high prediction accuracy, which was helpful clinicians to analyze the prognosis of PDAC with DM and implement individualized diagnosis and treatment.

Pancreatic mucinous adenocarcinoma has different clinical characteristics and better prognosis compared to non-specific PDAC: A retrospective observational study

“…This observation is reflected in TNM staging, where the M1 stage (HR = 1.21, 95 % CI: 1.04–1.40) emerges as an independent prognostic risk factor for PMAC. This corroborates findings from numerous studies on PDAC [ [31] , [32] , [33] ], underscoring the limited efficacy of current treatment modalities in managing advanced PDAC.…”

Innate and adaptive immune-directed tumour microenvironment in pancreatic ductal adenocarcinoma

“…It is predicted that pancreatic cancer-related death will overtake lung cancer as the second most prevalent cause of cancer-related death in the United States by 2030 ( 6 ). Along with the aggressive tumour biology, the pancreas’ central placement within the abdominal cavity, the lack of a distinct organ capsule, and the abundance of nearby blood and lymphatic arteries all contribute to the tumor’s ability to spread locally and elsewhere such as liver, lung, bone and brain ( 7 ). The pancreas, a comparatively clean organ, with very few lymphocytes, is located in the retroperitoneum and has no direct contact with the outside world; instead, it communicates with the digestive tract solely through the pancreatic duct.…”

HER3- A key survival pathway and an emerging therapeutic target in metastatic colorectal cancer and pancreatic ductal adenocarcinoma

“…Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths in the United States and is predicted to become second within the next decade [ 4 ]. Nearly 50% of patients with PDAC have metastasis at the time of diagnosis and almost all patients with PDAC eventually develop distant metastasis [ 5 – 7 ]. Treatments are only marginally effective in patients with metastatic diseases, and the 5-year survival rates of metastatic CRC (mCRC) and metastatic PDAC (mPDAC) are 15.1% and 3.1%, respectively [ 2 , 5 ].…”