Genetic Drivers of Pancreatic Cancer Are Identical Between the Primary Tumor and a Secondary Lesion in a Long-Term (>5 Years) Survivor After a Whipple Procedure

416 Background: The outcomes of patients (pts) with advanced pancreatic cancer (APC) are poor. With the use of currently available multi-agent regimens, median overall survival (mOS) remains < 12 months. Select pts, however, experience a protracted survival. Little is known about the clinical, pathologic and treatment characteristics associated with long term survival (LTS) in APC. Methods: Pooled individual level data from six Canadian cancer centers of pts diagnosed with APC from 2012 to 2016 who received at least one cycle of chemotherapy (CT) were analyzed. Clinical, pathologic and treatment characteristics, as well as survival, were compared between pts who lived < and ≥ 18 months. Multivariable logistic regression was used to identify independent predictors of survival. Results: Of 455 pts, 96% had metastatic disease and 88 (19%) survived ≥ 18 months. Compared to pts who survived < 18 months, those with LTS had lower WBC (p = 0.0025), CA 19-9 (p < 0.001), ALP (p < 0.001) and LDH (p = 0.007) at baseline. Pts with LTS also had higher albumin (p < 0.001) and BMI (p = 0.0268). In addition, they had better ECOG (p < 0.001) and were more likely to have tumors in the head of the pancreas (p = 0.0204). LTS pts were more likely to have a complete response (CR) or partial response (PR) to 1L CT (p < 0.001). The mOS seen with LTS was 29.2 months, compared to 4.3 months (p < 0.001). On multivariable logistic regression, independent predictors of LTS included: primary tumor in the head of the pancreas (OR 3.42 95% CI 1.2-9.76); experiencing a CR or PR to 1L CT (OR 9.19 95% CI 3.78-22.32); and receipt of 2L doublet CT (OR 2.72 95% CI 1.05 to 7.08). Conversely, factors associated with lower likelihood of LTS included: ECOG ≥ 2 (OR 0.32 95% CI 0.11-0.95); and elevated CA 19-9 (OR 0.43 95% CI 0.21-0.9). Conclusions: A select proportion of pts with APC experience LTS and have clinical features which differentiate them from those without LTS. The use of performance status, primary tumor location, pre-treatment CA 19-9, 2L CT type and radiologic response may help identify LTS and inform discussions regarding treatment and prognosis.

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Long-term survival after Whipple procedure and two subsequent multiorgan resections for pancreatic cancer relapses. Case report

Pancreatology ◽

10.1016/j.pan.2012.11.133 ◽

2012 ◽

Vol 12 (6) ◽

pp. 540

Author(s):

V.I. Egorov ◽

A.F. Kharazov ◽

V.A. Vishnevsky ◽

T.V. Schevchenko ◽

I.A. Kazakov ◽

...

Keyword(s):

Pancreatic Cancer ◽

Case Report ◽

Whipple Procedure ◽

Term Survival ◽

Long Term Survival

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Faculty Opinions recommendation of Identification of unique neoantigen qualities in long-term survivors of pancreatic cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732091698.793559550 ◽

2019 ◽

Author(s):

Jay Berzofsky

Keyword(s):

Pancreatic Cancer ◽

Long Term Survivors

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Generalized mycobacteriosis with secondary lesions of the spine in HIV positive patients

MedAlliance ◽

10.36422/23076348-2020-8-1-54-60 ◽

2020 ◽

Vol 8 (1) ◽

pp. 54-60

Keyword(s):

Antibiotic Therapy ◽

Granulomatous Inflammation ◽

Hiv Positive ◽

Hiv Patients ◽

Histological Picture ◽

Clinical Observations ◽

Spinal Lesion ◽

Secondary Lesion

2 clinical observations of generalized forms of mycobacteriosis in HIV (+) patients complicated by secondary spinal lesion are described. Anamnestic data on the presence of mycobacteriosis of the lungs allowed to suspect a secondary lesion of the spine. Verification of the diagnosis is possible only with bacteriological confirmation, since the histological picture is nonspecific and resembles tuberculous granulomatous inflammation. Treatment of spondylitis caused by non-tuberculous mycobacteria is complex and includes both surgical rehabilitation of the focus and long-term (at least 1 year) antibiotic therapy.

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RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS AND THE RISK OF CANCER AFTER SURGICAL TREATMENT

Problems in oncology ◽

10.37469/0507-3758-2018-64-2-228-233 ◽

2018 ◽

Vol 64 (2) ◽

pp. 228-233

Author(s):

Vladimir Lubyanskiy ◽

Vasiliy Seroshtanov ◽

Ye. Semenova

Keyword(s):

Pancreatic Cancer ◽

Chronic Pancreatitis ◽

Surgical Treatment ◽

Fibrous Tissue ◽

Pancreatic Head ◽

Head Region ◽

Intestinal Anastomoses ◽

Resection Of The Pancreas ◽

Risk Of Cancer

The aim: To analyze results of surgical treatment of patients with chronic pancreatitis (CP) and to assess the causes of pancreatic cancer after surgical treatment. Materials and methods: 137 patients had duodenum-preserving resections of the pancreas. Results: In the histological examination of the pancreas it was established that the growth of fibrous tissue was registered in patients with CP., which in 19 (13.8%) almost completely replaced the acinar tissue. In the long term after the operation from 6 months to 2 years in 8 patients (5.8%) pancreatic cancer was detected. Possible causes of tumor origin were analyzed, the value of preservation of ductal hypertension, which affects the state of the duct’s epithelium, was established. The most commonly used for treatment of chronic pancreatitis the Frey surgery removed pancreatic hypertension but in two patients during the operation an insufficient volume of the pancreatic head was reconstructed. In the case of the abandonment of a large array of fibrous tissue, local hypertension was retained in the region of the ductal structures of the head, which led to the transformation of the duct epithelium. An essential factor in the problem of the preservation of pancreatic hypertension were the stenosis of pancreatic intestinal anastomoses, they arose in the long term in 4 operated patients. With stenosis of anastomosis after duodenum-preserving resection both the hypertension factor and the regeneration factor could be realized, which under certain circumstances might be significant. Conclusion: After resection of the pancreas for CP cancer was diagnosed in 5.8% of patients. The main method of preventing the risk of cancer was performing the Frey surgery for CP eliminating pancreatic hypertension in the head region of the pancreas. Diagnosis of stenosis in the late period after resection of the pancreas was an important element in the prevention of recurrence of cancer since a timely reconstructive operation could improve the drainage of duct structures.

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P-106 Descriptive study of long-term survivors with advanced pancreatic cancer

Annals of Oncology ◽

10.1016/j.annonc.2021.05.161 ◽

2021 ◽

Vol 32 ◽

pp. S134

Author(s):

V. Aviñó Tarazona ◽

M. Amor Urbano ◽

L. Sanchez Escudero ◽

M. Bolaños Naranjo

Keyword(s):

Pancreatic Cancer ◽

Advanced Pancreatic Cancer ◽

Descriptive Study ◽

Long Term Survivors

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Survival Among Patients With Pancreatic Cancer and Long-Standing or Recent-Onset Diabetes Mellitus

Journal of Clinical Oncology ◽

10.1200/jco.2014.57.5688 ◽

2015 ◽

Vol 33 (1) ◽

pp. 29-35 ◽

Cited By ~ 45

Author(s):

Chen Yuan ◽

Douglas A. Rubinson ◽

Zhi Rong Qian ◽

Chen Wu ◽

Peter Kraft ◽

...

Keyword(s):

Pancreatic Cancer ◽

Median Survival ◽

Case Series ◽

Health Study ◽

Survival Times ◽

Recent Onset ◽

Onset Diabetes ◽

Diabetes Status ◽

The Impact

Purpose Long-standing diabetes is a risk factor for pancreatic cancer, and recent-onset diabetes in the several years before diagnosis is a consequence of subclinical pancreatic malignancy. However, the impact of diabetes on survival is largely unknown. Patients and Methods We analyzed survival by diabetes status among 1,006 patients diagnosed from 1986 to 2010 from two prospective cohort studies: the Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). We validated our results among 386 patients diagnosed from 2004 to 2013 from a clinic-based case series at Dana-Farber Cancer Institute (DFCI). We estimated hazard ratios (HRs) for death using Cox proportional hazards models, with adjustment for age, sex, race/ethnicity, smoking, diagnosis year, and cancer stage. Results In NHS and HPFS, HR for death was 1.40 (95% CI, 1.15 to 1.69) for patients with long-term diabetes (> 4 years) compared with those without diabetes (P < .001), with median survival times of 3 months for long-term diabetics and 5 months for nondiabetics. Adjustment for a propensity score to reduce confounding by comorbidities did not change the results. Among DFCI patient cases, HR for death was 1.53 (95% CI, 1.07 to 2.20) for those with long-term diabetes compared with those without diabetes (P = .02), with median survival times of 9 months for long-term diabetics and 13 months for nondiabetics. Compared with nondiabetics, survival times were shorter for long-term diabetics who used oral hypoglycemics or insulin. We observed no statistically significant association of recent-onset diabetes (< 4 years) with survival. Conclusion Long-standing diabetes was associated with statistically significantly decreased survival among patients with pancreatic cancer enrolled onto three longitudinal studies.

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Current Status and Long-term Outcome of Neoadjuvant Chemoradiotherapy for Resectable Pancreatic Cancer

HPB ◽

10.1016/j.hpb.2020.11.140 ◽

2021 ◽

Vol 23 ◽

pp. S58

Author(s):

K. Nakagawa ◽

T. Akahori ◽

K. Nakamura ◽

T. Takagi ◽

N. Ikeda ◽

...

Keyword(s):

Pancreatic Cancer ◽

Neoadjuvant Chemoradiotherapy ◽

Current Status ◽

Resectable Pancreatic Cancer ◽

Term Outcome ◽

Long Term Outcome

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Biliary Obstruction: Endoscopic Approaches

Seminars in Interventional Radiology ◽

10.1055/s-0037-1608828 ◽

2017 ◽

Vol 34 (04) ◽

pp. 369-375 ◽

Cited By ~ 6

Author(s):

Tomas DaVee ◽

Jeffrey Lee

Keyword(s):

Pancreatic Cancer ◽

Biliary Obstruction ◽

Epigastric Pain ◽

Surgical Techniques ◽

Malignant Biliary Obstruction ◽

Metal Stents ◽

Biliary Stents ◽

Term Survival ◽

Painless Jaundice

AbstractPainless jaundice is a harbinger of malignant biliary obstruction, with the majority of cases due to pancreatic adenocarcinoma. Despite advances in treatment, including improved surgical techniques and neoadjuvant (preoperative) chemotherapy, long-term survival from pancreatic cancer is rare. This lack of significant improvement in outcomes is believed to be due to multiple reasons, including the advanced stage at diagnosis and lack of an adequate biomarker for screening and early detection, prior to the onset of jaundice or epigastric pain. Close attention is required to select appropriate patients for preoperative biliary decompression, and to prevent morbid complications from biliary drainage procedures, such as pancreatitis and cholangitis. Use of small caliber plastic biliary stents during endoscopic retrograde cholangiopancreatography should be minimized, as metal stents have increased area for improved bile flow and a reduced risk of adverse events during neoadjuvant therapy. Efforts are underway by translational scientists, radiologists, oncologists, surgeons, and gastroenterologists to augment lifespan for our patients and to more readily treat this deadly disease. In this review, the authors discuss the rationale and techniques of endoscopic biliary intervention, mainly focusing on malignant biliary obstruction by pancreatic cancer.

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