Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2015; 21(1): 262-268
Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.262
Long-term survival after resection of pancreatic cancer: A single-center retrospective analysis
Takehito Yamamoto, Shintaro Yagi, Hiromitsu Kinoshita, Yusuke Sakamoto, Kazuyuki Okada, Kenji Uryuhara, Takeshi Morimoto, Satoshi Kaihara, Ryo Hosotani
Takehito Yamamoto, Shintaro Yagi, Hiromitsu Kinoshita, Yusuke Sakamoto, Kazuyuki Okada, Kenji Uryuhara, Satoshi Kaihara, Ryo Hosotani, Department of Surgery, Kobe City Medical Center General Hospital, Hyogo 650-0047, Japan
Takeshi Morimoto, Chief Statistician, Clinical Research Center, Kobe City Medical Center General Hospital, Hyogo 650-0047, Japan
Author contributions: Yagi S and Hosotani R performed the majority of the analyses; Kinoshita H, Sakamoto Y, Okada K, Uryuhara K and Kaihara S edited the manuscript; Morimoto T performed the statistical analyses; Yamamoto T designed the study and wrote the manuscript.
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: Takehito Yamamoto, MD, Department of Surgery, Kobe City Medical Center General Hospital, Minatojima Minamimachi 2-1-1, Chuo-ku, Kobe, Hyogo 650-0047, Japan. tkht26@me.com
Telephone: +81-78-3024321 Fax: +81-78-3027537
Received: May 16, 2014
Peer-review started: May 16, 2014
First decision: June 18, 2014
Revised: June 30, 2014
Accepted: July 29, 2014
Article in press: July 30, 2014
Published online: January 7, 2015
Processing time: 235 Days and 16.3 Hours
Abstract

AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.

METHODS: From January 2000 to December 2011, 195 patients underwent pancreatic resection in our hospital. The prognostic factors after pancreatic resection were analyzed in all 195 patients. After excluding the censored cases within an observational period, the clinicopathological characteristics of 20 patients who survived ≥ 5 (n = 20) and < 5 (n = 76) years were compared. For this comparison, we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years. For statistical analyses, the log-rank test was used to compare the cumulative survival rates, and the χ2 and Mann-Whitney tests were used to compare the two groups. The Cox-Hazard model was used for a multivariate analysis, and P values less than 0.05 were considered significant. A multivariate analysis was conducted on the factors that were significant in the univariate analysis.

RESULTS: The median survival for all patients was 27.1 months, and the 5-year actuarial survival rate was 34.5%. The median observational period was 595 d. With the univariate analysis, the UICC stage was significantly associated with survival time, and the CA19-9 ≤ 200 U/mL, DUPAN-2 ≤ 180 U/mL, tumor size ≤ 20 mm, R0 resection, absence of lymph node metastasis, absence of extrapancreatic neural invasion, and absence of portal invasion were favorable prognostic factors. The multivariate analysis showed that tumor size ≤ 20 mm (HR = 0.40; 95%CI: 0.17-0.83, P = 0.012) and negative surgical margins (R0 resection) (HR = 0.48; 95%CI: 0.30-0.77, P = 0.003) were independent favorable prognostic factors. Among the 96 patients, 20 patients survived for 5 years or more, and 76 patients died within 5 years after operation. Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2 (79.5 vs 312.5 U/mL, P = 0.032), tumor size ≤ 20 mm (35% vs 8%, P = 0.008), R0 resection (95% vs 61%, P = 0.004), and absence of lymph node metastases (60% vs 18%, P = 0.036) were significantly associated with the 5-year survival.

CONCLUSION: Negative surgical margins and a tumor size ≤ 20 mm were independent favorable prognostic factors. Histologically curative resection and early tumor detection are important factors in achieving long-term survival.

Keywords: Pancreatic cancer; Long-term survival; Long-term survivor; Prognostic factor; R0 resection

Core tip: The prognosis of pancreatic cancer patients remains quite poor. In this study, however, the 5-year actuarial survival rate was much higher (34.5%) than normal. Histologically curative resection and early tumor detection were important factors in achieving long-term survival.