An inflammatory subtype of pancreatic ductal adenocarcinoma is associated with poor prognosis and increased perioperative mortality

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a malignancy characterized by an aggressive tumor behavior. The present analysis seeks to identify and analyze a cohort that meets criteria for “inflammatory” PDAC (IPDAC). All patients who underwent a curative resection for PDAC at our institution between 1989 and 2015 were included in the retrospective analysis. Patients with histological proven adenocarcinoma and elevated C-reactive protein (CRP) (≥6 mg/L) serum concentrations, but no other suspicion of infection were included. We provide a matched control group with normal CRP serum levels from the same patient cohort. Thirty-six (6.8%) of 532 patients meet our criteria for an IPDAC group type. In-hospital (30 days) mortality was 13.9% in the IPDAC group vs 0% in the control group (P = .020). Median follow-up was 183.8 months (standard deviation [SD] = 53.3, range 14.3–285.4). Median overall survival was 8.5 months (SD = 16.8, range 0.3–89.6) in the IPDAC group and 24.8 months (SD = 19.4, range 0.7–80.4) in the control group (P = .002). Patients indicating an IPDAC in our cohort had a significantly and clinical meaningful decreased overall survival and a higher perioperative morbidity and mortality.