O147 The incidence and impact of pattern of metastases on treatment strategy and outcomes for patients with pancreatic cancer

Abstract

Background Pancreatic cancer is a major cause of cancer mortality with dismal survival outcomes. At the time of diagnosis, 15% of patients with pancreatic cancer have resectable disease, 35% present with locally advanced pancreatic cancer and 50% of patients present with metastatic disease. This study aimed to determine the pattern of metastatic disease in patients with pancreatic cancer and evaluate their influence on survival outcomes. Methods Electronic healthcare records were retrospectively reviewed at a regional hepatopancreaticobiliary centre to identify patients diagnosed with pancreatic cancer between 2010-2019 inclusive. Patient demographics, tumour characteristics, metastatic pattern and management were recorded and compared. Kaplan Meier survival analysis were used to assess survival outcomes stratified by sex, metastatic pattern, and treatment strategy. Results Of the 1293 patients who met the inclusion criteria, metastatic disease was present in 863 (69.1%) at diagnosis. The commonest site of metastases was liver only [25.6% (221/863], followed by disseminated metastases [24.1% (208/863)] and regional lymph nodes [22.9% (198/863)]. Only 3.7% (32/863) of patients with metastases had lung-only metastases. Detection of lung metastases synchronous with intra-abdominal metastases did not alter management. The surgical resection rate was only 15% and the 5-year survival for those who underwent surgery was 9.8% compared with 0.8% for those with unresectable disease (p<0.0001). Conclusion A large proportion of patients with pancreatic cancer were diagnosed with metastatic disease with the liver being the commonest site. Metastases reduce resectability rates and consequently lead to poor 5-year survival outcomes.