Evaluating survival in patients with pancreatic adenocarcinoma and lung metastasis.

e16237 Background: Pancreatic adenocarcinoma most commonly metastasizes to the liver and peritoneum, yet can occasionally metastasize to the lungs in an isolated fashion. Anecdotal evidence suggests that patients who have isolated metastatic disease to the lungs have improved outcomes. We sought to investigate whether pancreatic cancer lung metastasis is associated with improved survival. Methods: We conducted a retrospective review of patients within the Scripps Health system with pathologically confirmed pancreatic adenocarcinoma from 2017 to 2020. Primary sites of metastatic disease were identified with imaging, and when available, confirmed by pathology. A subgroup of 101 patients from a total cohort of 598 patients was further refined to only include patients with lung and/or liver primary metastases (N=68). Analyses were conducted on subgroups defined by metastatic sites of disease in the liver only, lung only and combined liver+lung. Primary and secondary outcome analyses compared isolated lung versus liver/liver+lung. Overall survival (OS) was defined from the date of diagnosis to date of death or most recent follow up, and recurrence free survival (RFS) from the time of diagnosis to date of recurrence. Each survival outcome was analyzed using Cox Proportional Hazards tests. Additionally, proportions of each subgroup (lung v. liver/liver+lung) that had recurrence or were deceased were reported and compared by Fisher’s exact tests. Results: No significant differences were observed in OS (HR 1.91, CI 0.66 – 3.73; p= 0.311) or RFS (HR 0.98, CI 0.42 – 2.30; p= 0.968) between patients with primary lung metastases versus those with either liver or liver+lung metastases (reported as hazard ratios of liver/liver+lung relative to lung only). Although there was no overall statistically significant difference, the kaplan-meier curve for OS appears to show improved survival for patients with primary lung metastasis initially but then ultimately shows worse survival compared to liver only metastasis at later time points. Please see Table.Conclusions: We found no difference in survival outcomes among pancreatic cancer patients with only lung metastasis at diagnosis compared to patients with hepatic metastasis. However, we do observe that patients with lung metastases seem to have improved survival initially. This study was conducted on a small set of the total number of patients with pancreatic adenocarcinoma within the Scripps Health system. Further analysis is ongoing to confirm the trend we observe in this study.[Table: see text]

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Incidence and Survival of Thyroid Cancer with Lung Metastasis

10.21203/rs.3.rs-161618/v1 ◽

2021 ◽

Author(s):

Miaochun Zhong ◽

Xianghong He ◽

Lingfei Cui ◽

Kefeng Lei

Keyword(s):

Overall Survival ◽

Thyroid Cancer ◽

Brain Metastasis ◽

Bone Metastases ◽

Lung Metastasis ◽

Lung Metastases ◽

Statistical Significance ◽

Cancer Specific Survival ◽

Isolated Lung ◽

Significant Difference

Abstract Background: Thyroid cancer (TC) is common malignancy. Lung metastasis is one of the top metastases for TC. The incidence and survival rates of TC with lung metastasis remains unclear.Methods: Data on TC with lung metastasis and other site-specific metastases were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The chi-square tests were employed to compare the clinicopathological characteristics among patients with different sites of metastases. Kaplan-Meier analysis and log-rank tests were used for survival analysis. A Cox proportional model was used for multivariate analyses of the patient population. Statistical significance indicated by a two-tailed P value < 0.05. Results: A total of 77322 patients with TC and known sites of distant metastases were identified from 2010-2016. The probability of isolated lung metastasis was significantly higher than that of isolated distant metastasis to other sites among TC patients (P < 0.05). Patients with isolated lung metastases had worse overall and thyroid cancer-specific survival compared to patients with isolated bone metastases (P < 0.05). There was a slight difference in thyroid cancer-specific survival between patients with lung metastasis and patients with liver metastasis(P=0.0496), while there was no significant difference in overall survival. (P >0.05). There was no significant difference in overall survival or thyroid cancer specific survival between patients with lung metastasis and those with brain metastasis (P > 0.05). Multivariate analysis revealed that white race was associated with better outcomes in terms of both endpoints in the lung metastasis population.Conclusions: The incidence of lung metastasis from TC was higher than that of other organ metastases. Thyroid cancer patients with isolated lung metastases have worse outcomes compared to patients with isolated bone metastases and liver metastases, whereas is similar to brain metastasis. There was the worst survival outcome on patients with multi-organ metastases.

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Revisiting the prognostic significance of positive peritoneal cytology in pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.177 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 177-177

Author(s):

Kathryn T. Chen ◽

Smit Singla ◽

Pavlos Papavasiliou ◽

Karthik Devarajan ◽

John Parker Hoffman

Keyword(s):

Pancreatic Cancer ◽

Neoadjuvant Therapy ◽

Pancreatic Adenocarcinoma ◽

Metastatic Disease ◽

Prognostic Significance ◽

Stage Ii ◽

Peritoneal Cytology ◽

Cart Analysis ◽

Significant Difference ◽

Positive Peritoneal Cytology

177 Background: Positive peritoneal cytology (PPC) in the setting of pancreatic cancer predicts a poor prognosis, such that it is considered metastatic disease in the American Joint Commission on Cancer staging guidelines. We re-evaluate the role of PPC, with particular attention to outcomes following neoadjuvant therapy. Methods: We retrospectively identified 185 patients from January 1, 2000 to present with the diagnosis of pancreatic adenocarcinoma who had undergone peritoneal washings with cytology at the time of planned resection. Data regarding demographics, tumor stage, intraoperative cytology, surgical and chemoradiation therapeutics, and clinicopathological outcomes were analyzed, with the primary endpoints being disease-free and overall survival (DFS and OS). Results: 20 patients (11%) had PPC at the time of planned resection; of these, 11 patients (55%) received neoadjuvant therapy prior to surgery. 165 patients (89%) had negative peritoneal cytology (NPC) at the time of planned resection; of these, 75 (45%) received neoadjuvant therapy prior to surgery. All patients proceeded with resection in the absence of visible metastatic disease. 42% of NPC reached 2-year survival compared to just 20% of patients with PPC. Overall, patients with PPC vs. NPC had significantly poorer DFS (p<0.0064) and OS (p<0.0135). When stratifying by neoadjuvant therapy, in those patients with stage II disease or higher who did not receive neoadjuvant therapy, multivariable CART analysis revealed that PPC predicted poorer DFS compared with NPC (p<0.004). However, among stage II or higher disease receiving neoadjuvant therapy, it failed to show a significant difference in DFS or OS between PPC and NPC. Conclusions: Overall, patients with positive peritoneal cytology are shown to have worse DFS and OS compared to patients with negative peritoneal cytology in pancreatic adenocarcinoma. However, after multivariable analysis, the prognostic significance of positive peritoneal cytology disappears in those patients with stage II and higher disease receiving neoadjuvant therapy.

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Incidence and Survival of Thyroid Cancer with Lung Metastasis

10.21203/rs.3.rs-161618/v2 ◽

2021 ◽

Author(s):

Miaochun Zhong ◽

Xianghong He ◽

Lingfei Cui ◽

Qiong Yang ◽

Kefeng Lei

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Thyroid Cancer ◽

Lung Metastasis ◽

Lung Metastases ◽

Statistical Significance ◽

Cox Proportional Hazards Model ◽

Cancer Specific Survival ◽

Isolated Lung ◽

Significant Difference

Abstract Background: Thyroid cancer (TC) is a common malignancy. Lung metastasis is one of the top metastases for TC. The incidence and survival rates of TC with lung metastasis remain unclear.Methods: Data on TC with lung metastasis and other site-specific metastases were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Chi-square tests were employed to compare the biological and clinical features of thyroid patients with different metastatic sites. Survival analysis was performed utilizing Kaplan-Meier analysis and log-rank tests. We used a Cox proportional hazards model for the multivariate analysis to identify prognostic factors of thyroid patients with lung metastases. Statistical significance was indicated by a two-tailed P value < 0.05.Results: A total of 77322 patients suffering from TC with clear metastasis information were identified from 2010-2016. The probability of isolated lung metastasis was significantly higher than that of isolated distant metastasis to other sites among TC patients (P < 0.05). Patients with isolated lung metastases had worse overall survival (OS) and thyroid cancer-specific survival (TCSS) than patients with bone metastasis only (P < 0.05). There was a slight difference in thyroid cancer-specific survival between patients with lung metastasis and patients with liver metastasis (P=0.0496), while there was no significant difference in overall survival. (P >0.05). There was no significant difference in OS or TCSS between patients with lung metastasis and those with brain metastasis (P > 0.05). Multivariate analysis revealed that white race was associated with better outcomes in terms of both endpoints in the lung metastasis population.Conclusions: The incidence of lung metastasis from TC was higher than that of other organ metastases. Thyroid cancer patients with isolated lung metastases have worse outcomes than patients with isolated bone metastases and liver metastases but are similar to brain metastases. There was the worst survival outcome in patients with multiorgan metastases.

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Role of FDG PET/CT scan in preoperative pancreatic cancer staging.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.511 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 511-511

Author(s):

Bhargavi Ghanta ◽

Thavam C. Thambi-Pillai ◽

Gary Timmerman ◽

Christopher Fischer ◽

Annie Nelson ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Adenocarcinoma ◽

Metastatic Disease ◽

Preoperative Staging ◽

False Negative ◽

Number Of Patients ◽

Pet Ct ◽

Hepatic Metastatic Disease ◽

Fdg Pet Ct

511 Background: Guidelines do not recommend routine FDG PET/CT (PET) as preoperative staging for pancreatic cancer, although many single center series have demonstrated that PET can lead to changes in management in a sizable minority of patients. We performed a retrospective analysis of patients undergoing PET for potentially resectable pancreatic adenocarcinoma at our institution to help define the utility of PET in this setting. Methods: We reviewed patients with pancreatic adenocarcinoma diagnosed at our center from June 2010 to May 2017 and included patients with pancreatic adenocarcinoma felt to be potentially resectable following standard staging studies [computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS)] who also underwent preoperative PET. Data collected and analyzed included: demographics, pre-PET staging, CA19-9 levels, PET results and surgical outcomes. Results: Forty eight patients with pancreatic adenocarcinoma felt to be surgically resectable underwent PET. PET changed management in 4/48 (8.3%) of these patients. In all 4 of these patients, hepatic metastatic disease was detected on PET and planned surgery was canceled; metastatic disease was confirmed by biopsy in 1 of these patients. 1/48 (2.1%) of patients had a false positive PET scan, where a focus of suspected metastatic disease on PET was biopsied and found to be benign, allowing the patient to proceed to surgery. 3/48 (6.3%) of patients had a false negative PET; 2 patients had hepatic metastatic disease and one had peritoneal disease discovered during surgery. Mean time from negative PET to surgery in these 3 patients was 31 days (range 21-45). Degree of CA19-9 elevation and primary tumor FDG avidity did not correlate with detection of metastatic disease on PET. Conclusions: PET changed management in a smaller number of patients in this cohort than in many previously reported series with a nearly equal number of patients with false negative PET results proceeding to unnecessary surgery. These results are consistent with the currently uncertain role of PET in preoperative staging for pancreatic cancer and further work must be undertaken to optimize presurgical staging in this population.

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Multidisciplinary management of pancreatic adenocarcinoma with isolated pulmonary metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.384 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 384-384

Author(s):

Supriya K. Jain ◽

Cheryl Meguid ◽

Stephen Leong ◽

Barish H. Edil ◽

Martin McCarter ◽

...

Keyword(s):

Overall Survival ◽

Pancreatic Adenocarcinoma ◽

Metastatic Disease ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Median Number ◽

Metastatic Pancreatic Adenocarcinoma ◽

Isolated Lung ◽

Investigational Agents ◽

Long Term Survivors

384 Background: Metastatic pancreatic adenocarcinoma (PAC) with isolated pulmonary metastases has recently been associated with prolonged overall survival. The purpose of this study was to review multi-disciplinary management and outcomes of these patients. Methods: Patients with PAC with pulmonary-only metastases were queried between 2012 to 2015 from a prospective single-institutional database. Results: Ten patients (median age: 71 yrs) were identified. Median number of lung metastases at diagnosis was 3 (range: 1 to innumerable). Seven patients had biopsy-proven lung metastases. Five presented with synchronous metastatic disease and five developed metachronous lung metastases as their first site of progression. Median time to progression between diagnosis of primary cancer to diagnosis of pulmonary metastases was 15 months (range: 4 to 31). Seven patients are alive as of this analysis. Median overall survival (OS) of this series (including two patients diagnosed 3 and 6 months ago) is 17 months, with longest overall survival = 40+ months (patient is still alive). All patients received gemcitabine-based chemotherapy; however, systemic regimens differed and included investigational agents. 3 of 5 patients with metachronous metastases underwent pancreaticoduodenectomy and are long-term survivors (34-40+ months). 2 of these 3 patients had diagnostic VATS of lung metastases and are alive with overall survival of 36+ months (resection of 2/3 nodules) and 34+ months (resection of all visible disease). Two patients with metachronous disease underwent neoadjuvant chemotherapy and pancreatic SBRT with progression to lung prior to planned surgery (OS: 30 months (deceased) and 6+ months (recently diagnosed)). 0 of 5 patients with synchronous metastatic disease had surgical resection; 3 of 5 received pancreatic SBRT. 3 of 10 patients are deceased due to visceral disease (14 months), pulmonary failure (18 months), and unknown causes (30 months). Conclusions: We report a recent single-institutional series of PAC with isolated lung metastases. Our data support that metastatic PAC patients with isolated pulmonary metastases have prolonged overall survival and suggest that local intervention may be beneficial.

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Appraisal of Aggressive Excisional Biopsy for a Possible Isolated Lung Metastasis of Pancreatic Cancer: Repeated Extirpation Contributes to Long Survival

International Surgery ◽

10.9738/intsurg-d-15-00013.1 ◽

2016 ◽

Vol 101 (5-6) ◽

pp. 257-262

Author(s):

Kana Takahashi ◽

Masato Yoshioka ◽

Hiroshi Uchinami ◽

Go Watanabe ◽

Kazuhiro Kudoh ◽

...

Keyword(s):

Pancreatic Cancer ◽

Distal Pancreatectomy ◽

Lung Metastasis ◽

Lung Metastases ◽

Excisional Biopsy ◽

Lung Field ◽

Tumor Nodule ◽

Free Survival ◽

Long Survival ◽

Isolated Lung

Although rare, there is a group of patients in whom lung metastases of pancreatic cancer develop isolatedly. We here report two cases of isolated lung metastasis of pancreatic cancer who gained long survival by repeated surgical resections of the nodules. Case 1: A 63-year-old man developed a 5-mm isolated lung metastasis 25 months after distal pancreatectomy for the primary cancer. He underwent an excisional biopsy for diagnosis and treatment. Although new lesions developed after this excision, additional extirpation of the chemotherapy-resistant tumor nodule realized a tumor-free survival for 15 months and total 74 months survival since pancreatectomy. Case 2: A 75-year-old man developed a 10-mm isolated lung metastasis of pancreatic cancer 13 months after distal pancreatectomy and underwent an excisional biopsy. In spite of adjuvant chemotherapy, 18 months later, a new lesion developed in the lung field neighboring the site of the first metastasis. He received a redo resection and has had a tumor-free period for 20 months until now. He has survived for 55 months since distal pancreatectomy. Aggressive excisional biopsy and repeated surgical resection could be recommended as a treatment option for isolated lung metastasis of pancreatic cancer.

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Is there an oligometastatic state in pancreatic cancer? Practical clinical considerations raise the question

British Journal of Radiology ◽

10.1259/bjr.20190627 ◽

2020 ◽

Vol 93 (1106) ◽

pp. 20190627

Author(s):

Marta Scorsetti ◽

Tiziana Comito ◽

Davide Franceschini ◽

Ciro Franzese ◽

Maria Giuseppina Prete ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Pancreatic Adenocarcinoma ◽

Local Treatment ◽

Stage Iv ◽

Progression Free Survival ◽

Free Survival ◽

Number Of Patients ◽

Clinical Considerations

Objectives: To evaluate the role of stereotactic body radiotherapy (SBRT) as a local ablative treatment (LAT) in oligometastatic pancreatic cancer. Methods: Patients affected by histologically confirmed stage IV pancreatic adenocarcinoma were included in this analysis. Endpoints are local control (LC), progression-free survival (PFS), and overall survival (OS). Results: From 2013 to 2017, a total of 41 patients were treated with SBRT on 64 metastases. Most common sites of disease were lung (29.3%) and liver (56.1%). LC at 1 and 2 years were 88.9% (95% CI 73.2–98.6) and 73.9% (95% CI 50–87.5), respectively. Median LC was 39.9 months (95% CI 23.3—not reached). PFS rates at 1 and 2 years were 21.9% (95% CI 10.8–35.4) and 10.9% (95% CI 3.4–23.4), respectively. Median PFS was 5.4 months (95%CI 3.1–11.3). OS rates at 1 and 2 years were 79.9% (95% CI 63.7–89.4) and 46.7% (95% CI 29.6–62.2). Median OS was 23 months (95%CI 14.1–31.8). Conclusions: Our results, although based on a retrospective analysis of a small number of patients, show that patients with oligometastatic pancreatic cancer may benefit from local treatment with SBRT. Larger studies are warranted to confirm these results. Advances in knowledge: Selected patients affected by oligometastatic pancreatic adenocarcinoma can benefit from local ablative approaches, like SBRT

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The Tumour Marker CA 195 in Colorectal and Pancreatic Cancer

The International Journal of Biological Markers ◽

10.1177/172460089100600405 ◽

1991 ◽

Vol 6 (4) ◽

pp. 241-246 ◽

Cited By ~ 4

Author(s):

P.M. Sagar ◽

O.M. Taylor ◽

E.H. Cooper ◽

E.A. Benson ◽

M.J. Mcmahon ◽

...

Keyword(s):

Colorectal Cancer ◽

Pancreatic Cancer ◽

Serum Level ◽

Pancreatic Adenocarcinoma ◽

Metastatic Disease ◽

Initial Level ◽

Tumour Marker ◽

Tumour Markers ◽

Normal Range ◽

Unresectable Disease

The aim of this study was to measure the serum level of the tumour markers CA 195 and CEA in patients with either colorectal or pancreatic cancer both before and at serial intervals after operation. CA 195 and CEA were measured in 199 patients with colorectal cancer and 52 patients with pancreatic cancer. The median concentrations of CA 195 were 3.0 u/ml (interquartile range 3.0-4.5 u/ml) in patients with a Dukes’ stage A lesion, 5.8 u/ml (3.0-18.2 u/ml) in patients with a Dukes’ stage B lesion, 6.1 u/ml (3.0-24.7 u/ml) in patients with a Dukes’ stage C and 23.8 u/ml (11.1-409.0 u/ml) in patients with metastatic disease (normal range 0-7 u/ml). The median levels of CEA were 2.6 ng/ml (1.7-3.3 ng/ml) for Dukes’ stage A, 3.3 ng/ml (1.7-7.2 ng/ml) for Dukes’ stage B, 3.7 ng/ml (2.2-7.9 ng/ml) for Dukes’ stage C and 34.5 ng/ml (13.3-289.4 ng/ml) for metastatic disease. A rising level of CA 195 or CEA after operation suggested recurrence of the tumour. In none of these patients was the recurrence operable. In patients with pancreatic adenocarcinoma, the level of CA 195 was significantly higher in patients with metastatic disease but it did not discriminate between resectable and unresectable disease. The duration of survival correlated with the initial level of CA 195 (Rs = –0.66, p < 0.001).

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SMAD4 gene mutation and prognosis of pancreatic adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.180 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 180-180

Author(s):

Olfa Derbel ◽

Arnaud de la Fouchardière ◽

Julien Peron ◽

Francoise Desseigne ◽

Pierre Heudel ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Adenocarcinoma ◽

Metastatic Disease ◽

Locally Advanced ◽

Chemotherapeutic Agents ◽

Clinicopathological Parameters ◽

Molecular Heterogeneity ◽

Smad4 Gene ◽

Mutational Status ◽

Smad4 Expression

180 Background: Pancreatic adenocarcinoma remains resistant to many key cytotoxic chemotherapeutic agents and novel targeted therapies. The molecular heterogeneity of this cancer may account for therapy failures to date, although the growing arsenal of novel targeted agents could translate into patient survival. A better understanding of the cellular and molecular features of advanced disease will afford new opportunities for investigation, therapeutic intervention and clinical management of patients afflicted with pancreatic cancer. Methods: Data of 46 patients with pancreatic adenocarcinoma were analyzed. The clinicopathological parameters, the histologic features were determined and correlated to the stage at initial diagnosis and patterns of failure (locally advanced v metastatic disease). Using tissue microarray, we assessed the relationship of SMAD4 expression with the overall survival of patients. Results: Among the 46 treated patients, 32 underwent pancreaticoduodenectomy. 40% of patients died with metastatic disease and 15 % died with locally advance evolution. Loss of SMAD4 expression was found in 22% of patients and seems to be correlated with a high grade histologic features and progression to metastasis disease. Complementary data about correlation between the mutational status of SMAD4 and survival will be presented during congress. Conclusions: SMAD4 gene inactivation seems to be associated with poorer prognosis and disease progression. Prospective validation of SMAD4 as a predictive biomarker may personalize treatment strategies for patients with pancreatic cancer.

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