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Pancreatic cancer as a systemic disease – real-world data from a Portuguese oncological centre
Background
Pancreatic adenocarcinoma account for 90% of pancreatic cancer. Only 20% present with resectable or borderline resectable disease, and one third of these patients harbor occult metastatic disease (OMD) not detected on preoperative imaging. Despite treatment improvements, it remained the 7th most lethal cancer in 2020, with a 5-years overall survival (OS) < 20%. CA 19.9 is the most established tumor marker, presenting a relationship with disease stage and outcome. Authors aim to characterize pancreatic cancer population of a Portuguese Center, their treatments and outcomes.
Methods
Retrospective analysis of pancreatic cancer patients diagnosed between January 1st 2015 and December 31st 2021 in a single hospital in Portugal. Clinic-pathological characteristics were accessed by reviewing medical records. A descriptive analysis was performed; Mann Whitney test and chi-square were used to compare continues and categorical variables, respectively, SPSS®20.
Results
123 patients were included. Median age was 71-years-old (37-98), 52% (n=64) were male. 43% (n=53) had an ECOG 0-1. Median preoperative CA 19.9 was 340.29 UI/mL (N < 37; 1.05-12000); median postoperative C 19.9 was 23.16 UI/mL (2-12000). At the diagnosis 31% (n=39) presented with a resectable disease, 2% (n=2) with borderline resectable, 15% (n=18) with unresectable and 52% (n=64) with metastatic disease. No differences in clinic-pathologic characteristics between localized and locally advanced/metastatic disease were found. Of the 41 patients with resectable/borderline resectable disease 90% underwent surgery, 8% had metastatic disease at surgery. Regarding post-surgery systemic treatment, 81% (n=30) were proposed to adjuvant chemotherapy, 8% (n=3) to palliative chemotherapy and 10% (n=4) for surveillance. Taking into account the patients proposed to adjuvant chemotherapy, 20% (n=6) had progressive disease at restaging; 10% (n=3) were unfit for chemotherapy. 22% (n=9) had OMD, being the postoperative CA 19.9 level related to this condition (p=.047). Regarding systemic adjuvant treatment, 23% (n=5) underwent chemoradiotherapy and 77% (n=17) chemotherapy [36% gemcitabine and capecitabine; 18% Nab-paclitaxel and gemcitabine; 14% gemcitabine and 9% mFOLFIRINOX]. 67% (n=14) recurred after adjuvant treatment - 36% were proposed to palliative chemotherapy. 51% (n=42) with locally advanced/metastatic disease were proposed to best supportive care, 43% (n=35) to systemic chemotherapy and 6% (n=5) died before therapeutic proposal. Systemic chemotherapy with palliative intent was offered to 43 patients, nab-paclitaxel and gemcitabine was the most common regimen (58%), followed by FOLFIRINOX (79%), 1 patient received liposomal irinotecan with 5-flurouracil in context of a clinical trial. After progression, 57% (n=22) underwent a second-line chemotherapy, being the most common regimen nab-paclitaxel gemcitabine (55%). The number of palliative-lines ranged from 1 to 4. Median OS was 8 months (1-83) in localized disease and 6 months (0-61) in locally advanced/metastatic disease; median time to progression was 11 months (8-14) and 7 months (4-9), respectively. No association between CA 19.9 and outcome was established.
Conclusions
As reported in the literature pancreatic cancer is a systemic disease, 22% of our sample presented OMD at diagnosis. This population prognosis remains poor despite the recent advances in systemic treatment. The rapid deterioration of patients’ clinical condition may impaired the systemic treatment and prognosis. Advances in acuity for OMD and treatment are urgently needed.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
