Surgical therapy of pancreatic cancer – 5 years survival

Česká verze

Authors: M. Loveček ¹; P. Skalický ² ; Dušan Klos ² ; Č. Neoral ²; J. Ehrmann jr. ³; J. Zapletalová ⁴; H. Švébišová ⁵; T. Yogeswara ¹; M. Ghothim ¹; R. Vrba ¹; R. Havlík ²
Authors place of work: I. chirurgická klinika, LF Univerzity Palackého Olomouc přednosta: prof. MUDr. Č. Neoral, CSc. ¹; I. chirurgická klinika, FN Olomouc přednosta: prof. MUDr. Č. Neoral, CSc. ²; Ústav klinické a molekulární patologie, LF Univerzity Palackého Olomouc přednosta: prof. MUDr. Z. Kolář, CSc. ³; Ústav lékařské biofyziky, LF Univerzity Palackého Olomouc přednosta: prof. RNDr. H. Kolářová, CSc. ⁴; Onkologická klinika, FN Olomouc přednosta prof. MUDr. B. Melichar, PhD. ⁵
Published in the journal: Rozhl. Chir., 2015, roč. 94, č. 11, s. 470-476.
Category: Původní práce

Summary

Introduction:
The purpose was to identify 5-year survivors among a group of radically resected patients with pancreatic cancer and analyse the characteristics and factors associated with their 5-year survival. Single tertiary centre experience.

Method:
A prospectively maintained database of 155 pancreatic resections from January 2006 to June 2010 was scanned to identify patients after curative radical resections for pancreatic ductal adenocarcinoma. The clinical and pathological data was analysed retrospectively. The outcomes of the PDAC group were evaluated using Kaplan-Meier analysis (survival) with the Log-rank test and Cox regression analysis (evaluation of prognostic factors). Characteristics of the survivors were discussed. Significance level of 0.05 was used. Those factors were used as independent variables for Cox regression analysis whose significant effect on survival was shown based on Kaplan-Meier analysis.

Results:
Among 155 patients undergoing a curative pancreatic resection, 73 had a pancreatic ductal adenocarcinoma. Fifteen patients (20.5%) after radical surgery survived over 5 years, 13 of whom are still alive. In the group of the survivors, the mean overall survival was 77.1 months (60−110) and the median survival was 74 months. The mean relapse-free interval in the group of the survivors was 63.3 months (14−110) with the median of 65 months. Factors associated with a longer survival included the absence of lymph node infiltration (p=0.031), uncomplicated postoperative course (p=0.025), absence of vascular invasion (p=0.017), no blood transfusions (p=0.015) and the use of postoperative therapy – predominantly chemotherapy (p=0.009). Significant independent predictors of survival included vascular invasion HR=2.239 (95%CI: 1.093−4.590; p=0.028), postoperative chemotherapy HR=2.587 (95%CI: 1.301−5.145; p=0.007) and blood transfusion HR=2.080 (95%CI: 1.027−4.212; p=0.042). The risk of death was increased 2.2 times in patients with vascular invasion, 2.1 times in patients with transfusions, and finally 2.6 times in those with no chemotherapy.

Conclusion:
Factors associated with an improved overall survival included: the absence of lymph node infiltration, an uncomplicated postoperative course, absence of vascular invasion, no need of blood transfusions, and finally the use of postoperative chemotherapy. Vascular invasion, use of blood transfusions and postoperative adjuvant chemotherapy were significant independent prognostic factors of survival.

Key words:
pancreatic cancer − survival − resection − mortality − morbidity

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