Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysis

Abstract

AIMTo evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database.METHODSSEER database (2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases (liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved.RESULTSA total of 13233 patients with stage IV pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases (for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001) (for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.CONCLUSIONPancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.

Bone metastasis as primary presentation of pancreatic ductal adenocarcinoma: A case report and literature review

“…Their occurrence represents a clinical issue leading to hypercalcemia, severe pain, and risk of spinal cord injury contributing to an unfavorable prognosis and a much worse quality of life . Gastrointestinal tumors metastasize less common to the skeleton with a particular low incidence in PDAC patients whose disease is characterized by a more frequent metastatization to liver, peritoneal cavity, and lungs . The most common site of bone metastases is the spine which is associated with back pain that could be confused with symptoms correlated with the primary tumor .…”

“…2 Gastrointestinal tumors metastasize less common to the skeleton with a particular low incidence in PDAC patients whose disease is characterized by a more frequent metastatization to liver, peritoneal cavity, and lungs. [3][4][5][6][7] The most common site of bone metastases is the spine which is associated with back pain that could be confused with symptoms correlated with the primary tumor. 8 In a few cases, the skeleton may represent its sole metastatic site.…”

Pancreatic Adenocarcinoma: Role of the Site-Specific of Metastases

“…Data from the case studies herein commented suggest that patients with lung-only PDC metastases or with isolated distant lymph node implants have better outcomes than those with liver-only metastases [1][2][3]. However, the physiopathology of involved mechanisms should be better cleared, moreover one should consider the role of Trousseau's syndrome on estimated survival time either in advanced-stage or in early phase cancer.…”

“…Recently, we have read very interesting papers about epidemiological features and the site-specific prognostic role played by metastases of Pancreatic Adenocarcinoma (PAC) [1][2][3]. PAC is a very ominous malignancy with a median survival less than 1 year for metastatic disease and about 2 years for resect disease, an overall 5-year survival rate around 5% to 8% for metastatic disease and about 30% in case of early diagnosis and early surgical resection [1,2].…”

“…Among 13233 patients with advanced PCA, 66.3% had single site of metastases; and the main affected organs were: Liver, lungs, bones and brain, by decreasing order of frequency [3].…”