OBJECTIVE To measure the rate of LTS in resected PDAC and determine the association between predictors of OS and LTS. SUMMARY BACKGROUND DATA Long-term survival (>5 y, LTS) remains rare in pancreatic ductal adenocarcinoma (PDAC). Multiple predictors of overall survival (OS) are known but their association with LTS remains unclear. METHODS An international, multicenter retrospective study was conducted. Included were patients from 2012-2019 with resected PDAC. Excluded were those with metastases at diagnosis or resection, R2 resections, and 90-day mortality. Predictors of OS were identified using multivariable Cox regression and their prevalence in patients with LTS assessed. LTS was calculated by excluding patients with shorter follow-up and predictors of LTS were identified using multivariable logistic regression. RESULTS 3,003 patients were included (27.4% received neoadjuvant chemotherapy). Elevated baseline CA19-9, high tumor grade, nodal disease, and perineural and lymphovascular invasion were negative independent predictors of OS, while receipt of adjuvant chemotherapy predicted improved OS (all P<0.05). LTS was observed in 220/2,436 patients (9.0%), of whom 198 (90%) harbored poor prognostic factors: elevated baseline CA19-9 (58.1%), poor tumor differentiation (51.0%), nodal disease (46.8%), and perineural invasion (76.0%). Of those without any of these four features, 50.0% achieved LTS as compared to 21.3%, 13.3%, 5.2%, and 3.5% in those with 1, 2, 3, or 4 features. CONCLUSIONS This bi-national cohort demonstrates a true LTS rate of 9.0% in resected PDAC. Clinicians should remain aware that presence of poor prognostic factors does not preclude LTS.

中文翻译：

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切除的胰腺导管腺癌长期幸存者的不良预后因素：一项国际多中心队列研究。


目的 测量切除的 PDAC 中 LTS 的发生率，并确定 OS 和 LTS 预测因子之间的关联。摘要背景数据 胰腺导管腺癌 (PDAC) 的长期生存率 (>5 y, LTS) 仍然很少见。总生存期 (OS) 的多种预测因素是已知的，但它们与 LTS 的关系仍不清楚。方法进行了一项国际、多中心回顾性研究。其中包括 2012 年至 2019 年接受 PDAC 切除的患者。排除的是诊断时有转移或切除、R2 切除和 90 天死亡率的患者。使用多变量 Cox 回归确定 OS 的预测因子，并评估其在 LTS 患者中的患病率。 LTS 的计算方法是排除随访时间较短的患者，并使用多变量逻辑回归确定 LTS 的预测因子。结果 纳入 3,003 名患者（27.4% 接受新辅助化疗）。基线 CA19-9 升高、肿瘤分级高、淋巴结疾病以及神经周围和淋巴血管侵犯是 OS 的阴性独立预测因子，而接受辅助化疗则预测 OS 改善（均为 P<0.05）。在 220/2,436 例患者 (9.0%) 中观察到 LTS，其中 198 例 (90%) 具有不良预后因素：基线 CA19-9 升高 (58.1%)、肿瘤分化差 (51.0%)、淋巴结疾病 (46.8%)、和神经周围侵犯（76.0%）。在没有这四个特征中的任何一个的人中，有 50.0% 的人实现了 LTS，而在具有 1、2、3 或 4 个特征的人中，这一比例为 21.3%、13.3%、5.2% 和 3.5%。结论 该跨国队列显示，切除 PDAC 后的真实 LTS 率为 9.0%。临床医生应始终意识到不良预后因素的存在并不排除 LTS。