Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2017; 23(10): 1872-1880
Published online Mar 14, 2017. doi: 10.3748/wjg.v23.i10.1872
Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysis
Hani Oweira, Ulf Petrausch, Daniel Helbling, Jan Schmidt, Meinrad Mannhart, Arianeb Mehrabi, Othmar Schöb, Anwar Giryes, Michael Decker, Omar Abdel-Rahman
Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland
Hani Oweira, Arianeb Mehrabi, Department of General, Visceral and Transplant Surgery, University of Heidelberg, 69120 Heidelberg, Germany
Hani Oweira, Jan Schmidt, Othmar Schöb, Surgical center Zurich - Hirslanden Hospital Zurich, 8001 Zurich, Switzerland
Ulf Petrausch, Swiss Tumor Immunology Institute, 8001 Zurich, Switzerland
Daniel Helbling, Gastrointestinal Tumor Center Zurich, 8001 Zurich, Switzerland
Meinrad Mannhart, Department of Oncology, Center of Zug, 6301 Zug, Switzerland
Michael Decker, Zentrum für Integrative Onkologie, 8001 Zurich, Switzerland
Omar Abdel-Rahman, Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11511, Egypt
Author contributions: Abdel-Rahman O conducted the analyses and wrote the manuscript; all other authors contributed to the idea of the manuscript and approved the final version.
Institutional review board statement: This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent statement: As this study is based on a publicly available database without identifying patient information, informed consent was not needed.
Conflict-of-interest statement: The authors declare they have no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at omar.abdelrhman@med.asu.edu.eg. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Omar Abdel-Rahman, Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11511, Egypt. omar.abdelrhman@med.asu.edu.eg
Telephone: +2-100-8541806 Fax: +2-100-6858397
Received: October 9, 2016
Peer-review started: October 11, 2016
First decision: December 19, 2016
Revised: December 20, 2016
Accepted: February 7, 2017
Article in press: February 8, 2017
Published online: March 14, 2017
Processing time: 155 Days and 13.1 Hours
Abstract
AIM

To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database.

METHODS

SEER database (2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases (liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved.

RESULTS

A total of 13233 patients with stage IV pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases (for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001) (for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.

CONCLUSION

Pancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.

Keywords: Pancreatic cancer; Liver metastases; Lung metastases; Bone metastases; Surveillance Epidemiology and End Results database

Core tip: Pancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.