Marina Baretti, Bhargavi Pulluri1, Hua-Ling Tsai2, Amanda L Blackford2, Christopher L Wolfgang3, Daniel Laheru, Lei Zheng, Joseph Herman4, Dung T Le, Amol K Narang5, Ana de Jesus-Acosta. 1. Department of Medicine, The University of Vermont Medical Center, Burlington, VT. 2. Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, The Johns Hopkins Biostatistics Center. 3. Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD. 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. 5. Departments of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
Abstract
OBJECTIVE: Limited data exist on the impact of ascites in pancreatic ductal adenocarcinoma (PDAC). We evaluated the survival outcomes of patients with PDAC and ascites. METHODS: Retrospective, single-institution, case-control study including patients with newly diagnosed PDAC from 2007 to 2016. One hundred fifty-four patients with ascites at diagnosis (case group) and 154 controls were matched on age, sex, stage, Eastern Cooperative Oncology Group performance, surgical treatment, lymph node, and margin status. Ascites was defined as computed tomography-detected fluid in the pelvic/peritoneal cavity. Overall survival was compared between groups via Cox proportional hazards models with a gamma frailty term to account for the correlation between matched pairs on entire cohort and by disease stages for subgroup analysis. RESULTS: The 154 matched cases included 24 resectable, 19 borderline resectable, 51 locally advanced, and 60 metastatic disease. Patients with ascites had higher risk of death compared with those without (conditional hazard ratio, 1.58; 95% confidence interval, 1.23-2.03; P < 0.001). Stratified analysis showed a significant association between ascites and poor prognosis in patients with localized disease (conditional hazard ratio, 1.62; 95% confidence interval, 1.18-2.24; P = 0.003). CONCLUSIONS: Radiographic ascites is a poor prognostic factor in PDAC. Our findings may aid physicians in considering systemic therapy prior to attempting local treatments.
OBJECTIVE: Limited data exist on the impact of ascites in pancreatic ductal adenocarcinoma (PDAC). We evaluated the survival outcomes of patients with PDAC and ascites. METHODS: Retrospective, single-institution, case-control study including patients with newly diagnosed PDAC from 2007 to 2016. One hundred fifty-four patients with ascites at diagnosis (case group) and 154 controls were matched on age, sex, stage, Eastern Cooperative Oncology Group performance, surgical treatment, lymph node, and margin status. Ascites was defined as computed tomography-detected fluid in the pelvic/peritoneal cavity. Overall survival was compared between groups via Cox proportional hazards models with a gamma frailty term to account for the correlation between matched pairs on entire cohort and by disease stages for subgroup analysis. RESULTS: The 154 matched cases included 24 resectable, 19 borderline resectable, 51 locally advanced, and 60 metastatic disease. Patients with ascites had higher risk of death compared with those without (conditional hazard ratio, 1.58; 95% confidence interval, 1.23-2.03; P < 0.001). Stratified analysis showed a significant association between ascites and poor prognosis in patients with localized disease (conditional hazard ratio, 1.62; 95% confidence interval, 1.18-2.24; P = 0.003). CONCLUSIONS: Radiographic ascites is a poor prognostic factor in PDAC. Our findings may aid physicians in considering systemic therapy prior to attempting local treatments.
Authors: Margaret A Tempero; Mokenge P Malafa; Mahmoud Al-Hawary; Horacio Asbun; Andrew Bain; Stephen W Behrman; Al B Benson; Ellen Binder; Dana B Cardin; Charles Cha; E Gabriela Chiorean; Vincent Chung; Brian Czito; Mary Dillhoff; Efrat Dotan; Cristina R Ferrone; Jeffrey Hardacre; William G Hawkins; Joseph Herman; Andrew H Ko; Srinadh Komanduri; Albert Koong; Noelle LoConte; Andrew M Lowy; Cassadie Moravek; Eric K Nakakura; Eileen M O'Reilly; Jorge Obando; Sushanth Reddy; Courtney Scaife; Sarah Thayer; Colin D Weekes; Robert A Wolff; Brian M Wolpin; Jennifer Burns; Susan Darlow Journal: J Natl Compr Canc Netw Date: 2017-08 Impact factor: 11.908
Authors: John DeWitt; Menggang Yu; Mohamad A Al-Haddad; Stuart Sherman; Lee McHenry; Julia K Leblanc Journal: Gastrointest Endosc Date: 2009-11-17 Impact factor: 9.427