Population-Based Study on Survival Determinants Following Pancreatoduodenectomy for Pancreatic Cancer

Abstract

Background. Majority of studies that have analyzed the determinants of long-term survival in post resection pancreatic cancer patients, have been single-institutional chart reviews yielding inconsistent results. Therefore factors, influencing survival following radical operations due to pancreatic adenocarcinoma are still ill defined.Objective. To analyze prognostic factors influencing pancreatic cancer survival following curative resection, using prospectively collected population-based data. Methods. Data was prospectively collected from 199 consecutive patients being resected for pancreatic adenocarcinoma at two HPB centers performing the vast majority of pancreatic resections in Lithuania. Overall survival probabilities were calculated using Kaplan-Meier method. All factors likely to be predictive of survival after pancreatic resection were evaluated by univariate analysis (Log-rank test). Multivariate analysis using Cox model was completed for all factors with p value B0.1 at univariate analysis. Results.Median survival of the patients was 15 months. Overall 1 , 3- and 5- year actuarial survival rates after resection for pancreatic adenocarcinoma were 56.3, 22.3 and 12.8 percent respectively with mean survival time of 26 months (95%CI: 21 31). Univariate analysis revealed that stage of the disease including T-stage and lymphnode positivity (N1), tumor differentiation grade and curative (R0) resection were main factors influencing survival for pancreatic cancer. Multivariate analyses through Cox proportional hazards survival analysis indicated that strongest predictors of survival were differentiation grade of the tumor (Hazard ratio 1.7 for less differentiated G3 G4 tumors) and curative resection (Hazard ratio 1.5 for R1). Conclusion. Although biologic characteristics remain important predictors of survival for patients with resected pancreatic cancer the survival rate could be determined by the radicality of resection.