D Ansari1, M Bauden1, S Bergström1, R Rylance2, G Marko-Varga3, R Andersson1. 1. Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden. 2. National Registry Centre, Skåne University Hospital, Lund University, Lund, Sweden. 3. Department of Biomedical Engineering, Clinical Protein Science and Imaging, Lund University, Lund, Sweden.
Abstract
BACKGROUND: The size of pancreatic ductal adenocarcinoma (PDAC) at diagnosis is an indicator of outcome. Previous studies have focused mostly on patients with resectable disease. The aim of this study was to investigate the relationship between tumour size and risk of metastasis and death in a large PDAC cohort, including all stages. METHODS: Patients diagnosed with PDAC between 1988 and 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Tumour size was defined as the maximum dimension of the tumour as provided by the registry. Metastatic spread was assessed, and survival was calculated according to size of the primary tumour using the Kaplan-Meier method. Cox proportional regression modelling was used to adjust for known confounders. RESULTS: Some 58 728 patients were included. There were 187 patients (0·3 per cent) with a tumour size of 0·5 cm or less, in whom the rate of distant metastasis was 30·6 per cent. The probability of tumour dissemination was associated with tumour size at the time of diagnosis. The association between survival and tumour size was linear for patients with localized tumours, but stochastic in patients with regional and distant stages. In patients with resected tumours, increasing tumour size was associated with worse tumour-specific survival, whereas size was not associated with survival in patients with unresected tumours. In the adjusted Cox regression analysis, the death rate increased by 4·1 per cent for each additional 1-cm increase in tumour size. CONCLUSION: Pancreatic cancer has a high metastatic capacity even in small tumours. The prognostic impact of tumour size is restricted to patients with localized disease.
BACKGROUND: The size of pancreatic ductal adenocarcinoma (PDAC) at diagnosis is an indicator of outcome. Previous studies have focused mostly on patients with resectable disease. The aim of this study was to investigate the relationship between tumour size and risk of metastasis and death in a large PDAC cohort, including all stages. METHODS:Patients diagnosed with PDAC between 1988 and 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Tumour size was defined as the maximum dimension of the tumour as provided by the registry. Metastatic spread was assessed, and survival was calculated according to size of the primary tumour using the Kaplan-Meier method. Cox proportional regression modelling was used to adjust for known confounders. RESULTS: Some 58 728 patients were included. There were 187 patients (0·3 per cent) with a tumour size of 0·5 cm or less, in whom the rate of distant metastasis was 30·6 per cent. The probability of tumour dissemination was associated with tumour size at the time of diagnosis. The association between survival and tumour size was linear for patients with localized tumours, but stochastic in patients with regional and distant stages. In patients with resected tumours, increasing tumour size was associated with worse tumour-specific survival, whereas size was not associated with survival in patients with unresected tumours. In the adjusted Cox regression analysis, the death rate increased by 4·1 per cent for each additional 1-cm increase in tumour size. CONCLUSION:Pancreatic cancer has a high metastatic capacity even in small tumours. The prognostic impact of tumour size is restricted to patients with localized disease.
Authors: Joshua D Cohen; Ammar A Javed; Christopher Thoburn; Fay Wong; Jeanne Tie; Peter Gibbs; C Max Schmidt; Michele T Yip-Schneider; Peter J Allen; Mark Schattner; Randall E Brand; Aatur D Singhi; Gloria M Petersen; Seung-Mo Hong; Song Cheol Kim; Massimo Falconi; Claudio Doglioni; Matthew J Weiss; Nita Ahuja; Jin He; Martin A Makary; Anirban Maitra; Samir M Hanash; Marco Dal Molin; Yuxuan Wang; Lu Li; Janine Ptak; Lisa Dobbyn; Joy Schaefer; Natalie Silliman; Maria Popoli; Michael G Goggins; Ralph H Hruban; Christopher L Wolfgang; Alison P Klein; Cristian Tomasetti; Nickolas Papadopoulos; Kenneth W Kinzler; Bert Vogelstein; Anne Marie Lennon Journal: Proc Natl Acad Sci U S A Date: 2017-09-05 Impact factor: 11.205
Authors: Dingyuan Hu; Daniel Ansari; Krzysztof Pawłowski; Qimin Zhou; Agata Sasor; Charlotte Welinder; Theresa Kristl; Monika Bauden; Melinda Rezeli; Yi Jiang; György Marko-Varga; Roland Andersson Journal: Oncotarget Date: 2018-01-03
Authors: Erin E Talbert; Heather L Lewis; Matthew R Farren; Mitchell L Ramsey; Jeffery M Chakedis; Priyani Rajasekera; Ericka Haverick; Angela Sarna; Mark Bloomston; Timothy M Pawlik; Teresa A Zimmers; Gregory B Lesinski; Phil A Hart; Mary E Dillhoff; Carl R Schmidt; Denis C Guttridge Journal: J Cachexia Sarcopenia Muscle Date: 2018-01-07 Impact factor: 12.910