Identification of Distinct Phenotypes of Locally Advanced Pancreatic Adenocarcinoma
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ORIGINAL RESEARCH
Identification of Distinct Phenotypes of Locally Advanced Pancreatic Adenocarcinoma MinYuen Teo & Grace F. Crotty & Criostóir O’Súilleabháin & Paul F. Ridgway & Kevin C. Conlon & Derek G. Power & Ray S. McDermott
Published online: 25 July 2012 # Springer Science+Business Media, LLC 2012
Abstract Background A significant number of pancreatic ductal adenocarcinoma present as locally advanced disease. Optimal treatment remains controversial. We sought to analyze the clinical course of locally advanced pancreatic adenocarcinoma (LAPC) in order to identify potential distinct clinical phenotypes. Methods Patients (pts) diagnosed with LAPC who survived >2 months were identified from institutional databases. Clinical details were collected. Sequential re-staging scans were reviewed. Progression-free survival (PFS), time from progression to death (TTD), and overall survival (OS) were estimated with Kaplan–Meier method and compared with log-rank test. Presented at the 2012 ASCO Gastrointestinal Cancers Symposium, January 19–21, 2012, San Francisco, CA, USA M. Teo (*) : R. S. McDermott Department of Medical Oncology, Adelaide & Meath Hospital incorporating National Children’s Hospital, Tallaght, Dublin, Ireland e-mail: [email protected] G. F. Crotty : D. G. Power Department of Medical Oncology, Mercy University Hospital, Grenville Place, Cork, Ireland C. O’Súilleabháin Department of Pancreatic & Hepatobiliary Surgery, Mercy University Hospital, Grenville Place, Cork, Ireland P. F. Ridgway : K. C. Conlon Professorial Surgical Unit, Department of Upper Gastrointestinal & Hepato-Pancreato-Biliary Surgery, Adelaide & Meath Hospital incorporating National Children’s Hospital, Tallaght, Dublin, Ireland
Results Between 2005 and 2011, 40 pts were identified. Median age was 66 yrs (range, 43–74) and 60 % (n024) were male. All pts received chemotherapy. Median OS was 11.3 months. Twenty patients (50 %) had local progression only (LP) and 16 (40 %) had metastatic progression (MP) at first documentation of progression, while four patients (10 %) had stable disease. PFS was 4.0 vs 5.6 months (hazard ratio (HR) 0.97; 95 % CI 0.49–1.93, p00.94) for LP and MP, respectively. Three of the patients with LP (15 %) eventually developed metastatic disease after a median of 4.2 months (3.7– 9.6). For MP patients, five had concurrent local progression. Sites of disease were lung (eight), peritoneum (five), liver (three), and bone (one). TTD for LP and MP was 5.6 vs 1.4 months (HR 0.62; 95 % CI 0.28– 1.39, p00.24) and OS was 13.2 vs 8.0 months (HR 0.59; 95 % CI 0.28–1.25, p00.017), respectively. Conclusions We identified two subgroups of LAPC with distinctive behavior, one local dominant progression with low predilection for metastases and another with rapid metastatic development and worse survival. Early recognition of these phenotypes might allow a more tailored treatment approach to improve outcome. Keywords Pancreatic neoplasm . Natural history . Biology . Chemotherapy
Introduction Pancreatic adenocarcinoma represents the fo
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