A simple matrix to predict treatment success and long-term survival among patients undergoing pancreatectomy

Abstract Background A more accurate measure of long-term survival among patients who have undergone a successful resection for pancreatic adenocarcinoma may be computed by accounting for time already survived during the initial treatment window. Methods Patients diagnosed with pancreatic adenocarcinoma, from 2004 through 2013, were identified from the American College of Surgeons National Cancer Database (NCDB). A risk-stratification matrix was constructed including age, histopathologic factors and the use of adjuvant therapy, given successful treatment and survival at 3-month following diagnosis. Results A total of 25,897 patients (50% male, 53% >65 years of age) presented with stage I–III pancreatic cancer. The majority of patients had tumors >2 cm size (82%), grade I/II (65%), lymphatic invasion (LI) (66%), and negative margins (76%). A survival advantage for adjuvant therapy was observed among all patients, independent of their risk-profile. For example, a patient ≤65 years of age, with early stage cancer (size ≤2 cm, grade I/II, −ve LI, −ve margins) who received adjuvant therapy had a 62% probability of being alive beyond three years (95%CI = 59%–66%). In contrast, the survival probability decreased to 53% (95%CI = 59%–66%) without adjuvant therapy. Conclusions These results provide surgeons and patients with more accurate information regarding long-term survival, as well as the benefit of opting for adjuvant therapy after successful pancreatic surgery.