Survival Benefit of Resection Surgery for Pancreatic Ductal Adenocarcinoma with Liver Metastases: A Propensity Score-Matched SEER Database Analysis

Pausch, Thomas; Liu, Xinchun; Cui, Jiaqu; Wei, Jishu; Miao, Yi; Heger, Ulrike; Probst, Pascal; Heap, Stephen; Hackert, Thilo

doi:10.3390/cancers14010057

Cited by 28 publications

(32 citation statements)

References 58 publications

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“…Two recent studies using the Surveillance, Epidemiology, and End Results (SEER) data found that PDAC patients with synchronous liver metastases who underwent pancreatectomy had better prognosis than those who did not undergo surgery. 13,14 However, the resection of metastatic liver lesions was not evaluated in studies based on SEER data. In SNUH cohort from this study, when dividing the cytoreductive surgery plus chemotherapy group according to curative-intent, median (IQR) OS was best for patients who underwent curativeintent surgery (22.0 [13.0-92.0] months) compared to those underwent noncurative intent surgery (15.0 [10.0-28.0] months), or (8.0 [5.0-12.0] months) chemotherapy alone (P < .001; Figure S4a).…”

Section: Discussionmentioning

confidence: 99%

The role of local treatment including pancreatectomy for pancreatic ductal adenocarcinoma patients with isolated synchronous liver metastasis: Propensity score‐matched analyses

Yun

Han

Lee

et al. 2023

J Hepato Biliary Pancreat

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BackgroundIn an era of more effective chemotherapy for pancreatic ductal adenocarcinoma (PDAC), the paradigm of local treatment is changing. However, the efficacy of local treatment in patients with isolated liver metastasis remains unclear. Therefore, we aimed to evaluate the effectiveness of pancreatectomy ± local treatment for metastasis (cytoreductive surgery) in PDAC patients with isolated synchronous liver metastasis.MethodsIn total, 239 patients with isolated liver metastasis were extracted from Seoul National University Hospital (SNUH). For comparison, another 12 637 patients were extracted from the National Cancer Database (NCDB). Propensity score matching was performed to minimize confounding in both cohorts. Survival analyses stratified by the treatment delivered were performed using Kaplan–Meier estimates and log‐rank tests.ResultsIn the SNUH cohort, the median (interquartile range) survival was 20.5 (13.0–42.0) months for patients who underwent cytoreductive surgery plus chemotherapy versus 12.0 (10.0–18.0) months for those who received chemotherapy alone (P < .001). With the NCDB cohort, the median (interquartile range) survival was 15.6 (8.9–31.2) months for patients who underwent cytoreductive surgery plus chemotherapy versus 7.4 (3.4–13.2) months for those who received chemotherapy alone (P < .001).ConclusionPatients with isolated synchronous liver metastasis should be considered for cytoreductive surgery in addition to effective chemotherapy.

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Section: Discussionmentioning

confidence: 99%

The role of local treatment including pancreatectomy for pancreatic ductal adenocarcinoma patients with isolated synchronous liver metastasis: Propensity score‐matched analyses

Yun

Han

Lee

et al. 2023

J Hepato Biliary Pancreat

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“…A study of 69 participants with concurrent liver metastases showed that participants who underwent simultaneous resection had a longer survival time significantly compared to those who did not undergo surgical resection (14 months vs 8 months, p < 0.01 ) ( 49 ). An analysis of the SEER database suggests that CDC (cancer–directed surgery) is capable of prolonging survival of oligometastatic PDAC patients ( 50 ). In addition, locally-ablative treatments like microwave ablation (MWA) and radiofrequency ablation (RFA) are considered complementary to radical surgery ( 51 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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.

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“…Such treatment options should be considered for carefully selected patients. Cancer-directed surgery reliably increased the median OS from 5 to 10 mo in patients with pancreatic ductal adenocarcinoma with LM in a propensity-matched analysis of the SEER database[ 33 ]. Furthermore, several types of PNETs are treated with cancer-directed surgery, regardless of LM[ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors, prognostic predictors, and nomograms for pancreatic cancer patients with initially diagnosed synchronous liver metastasis

Cao¹,

Tong²,

Zhang³

et al. 2023

World J Gastrointest Oncol

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BACKGROUND Liver metastasis (LM) remains a major cause of cancer-related death in patients with pancreatic cancer (PC) and is associated with a poor prognosis. Therefore, identifying the risk and prognostic factors in PC patients with LM (PCLM) is essential as it may aid in providing timely medical interventions to improve the prognosis of these patients. However, there are limited data on risk and prognostic factors in PCLM patients. AIM To investigate the risk and prognostic factors of PCLM and develop corresponding diagnostic and prognostic nomograms. METHODS Patients with primary PC diagnosed between 2010 and 2015 were reviewed from the Surveillance, Epidemiology, and Results Database. Risk factors were identified using multivariate logistic regression analysis to develop the diagnostic mode. The least absolute shrinkage and selection operator Cox regression model was used to determine the prognostic factors needed to develop the prognostic model. The performance of the two nomogram models was evaluated using receiver operating characteristic (ROC) curves, calibration plots, decision curve analysis (DCA), and risk subgroup classification. The Kaplan-Meier method with a log-rank test was used for survival analysis. RESULTS We enrolled 33459 patients with PC in this study. Of them, 11458 (34.2%) patients had LM at initial diagnosis. Age at diagnosis, primary site, lymph node metastasis, pathological type, tumor size, and pathological grade were identified as independent risk factors for LM in patients with PC. Age > 70 years, adenocarcinoma, poor or anaplastic differentiation, lung metastases, no surgery, and no chemotherapy were the independently associated risk factors for poor prognosis in patients with PCLM. The C- index of diagnostic and prognostic nomograms were 0.731 and 0.753, respectively. The two nomograms could accurately predict the occurrence and prognosis of patients with PCLM based on the observed analysis results of ROC curves, calibration plots, and DCA curves. The prognostic nomogram could stratify patients into prognostic groups and perform well in internal validation. CONCLUSION Our study identified the risk and prognostic factors in patients with PCLM and developed corresponding diagnostic and prognostic nomograms to help clinicians in subsequent clinical evaluation and intervention. External validation is required to confirm these results.

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Survival Benefit of Resection Surgery for Pancreatic Ductal Adenocarcinoma with Liver Metastases: A Propensity Score-Matched SEER Database Analysis

Cited by 28 publications

References 58 publications

The role of local treatment including pancreatectomy for pancreatic ductal adenocarcinoma patients with isolated synchronous liver metastasis: Propensity score‐matched analyses

The role of local treatment including pancreatectomy for pancreatic ductal adenocarcinoma patients with isolated synchronous liver metastasis: Propensity score‐matched analyses

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

Risk factors, prognostic predictors, and nomograms for pancreatic cancer patients with initially diagnosed synchronous liver metastasis

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