Oh SY, Edwards A, Mandelson MT, Lin B, Dorer R, Helton WS, Kozarek RA, Picozzi VJ. Rare long-term survivors of pancreatic adenocarcinoma without curative resection. World J Gastroenterol 2015; 21(48): 13574-13581 [PMID: 26730170 DOI: 10.3748/wjg.v21.i48.13574]
Corresponding Author of This Article
Stephen Y Oh, MD, Digestive Disease Institute, Virginia Mason Medical Center, 1100 9th Ave., MS: C3-GAS, Seattle, WA 98101, United States. oys801202@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Gastroenterol. Dec 28, 2015; 21(48): 13574-13581 Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13574
Rare long-term survivors of pancreatic adenocarcinoma without curative resection
Stephen Y Oh, Alicia Edwards, Margaret T Mandelson, Bruce Lin, Russell Dorer, W Scott Helton, Richard A Kozarek, Vincent J Picozzi
Stephen Y Oh, Alicia Edwards, Richard A Kozarek, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Margaret T Mandelson, Cancer Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Bruce Lin, Vincent J Picozzi, Department of Medical Oncology, Virginia Mason Medical Center, Seattle, WA 98101, United States
Russell Dorer, Department of Pathology, Virginia Mason Medical Center, Seattle, WA 98101, United States
W Scott Helton, Department of General Surgery, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: Oh SY collected data, performed analysis and wrote the manuscript; Edwards A and Mandelson MT collected data and performed analysis; Dorer R re-reviewed the pathology slides of all patients included in the study; Helton WS re-reviewed the staging CT on all patients included in the study, supervised data analysis and edited the manuscript; Kozarek RA and Picozzi VJ designed the study, supervised data analysis and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by the Virginia Mason Medical Center Institutional Review Board (IRB). Informed consent from individual patients was not required by the IRB given the nature of the study (retrospective review of medical records) and the lack of identifiable patient information in the study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
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: Stephen Y Oh, MD, Digestive Disease Institute, Virginia Mason Medical Center, 1100 9th Ave., MS: C3-GAS, Seattle, WA 98101, United States. oys801202@gmail.com
Telephone: +1-206-2232319 Fax: +1-206-2236379
Received: June 30, 2015 Peer-review started: July 4, 2015 First decision: July 19, 2015 Revised: August 11, 2015 Accepted: September 28, 2015 Article in press: September 30, 2015 Published online: December 28, 2015 Processing time: 177 Days and 6.4 Hours
Abstract
Long-term outcome data in pancreatic adenocarcinoma are predominantly based on surgical series, as resection is currently considered essential for long-term survival. In contrast, five-year survival in non-resected patients has rarely been reported. In this report, we examined the incidence and natural history of ≥ 5-year survivors with non-resected pancreatic adenocarcinoma. All patients with pancreatic adenocarcinoma who received oncologic therapy alone without surgery at our institution between 1995 and 2009 were identified. Non-resected ≥ 5-year survivors represented 2% (11/544) of all non-resected patients undergoing treatment for pancreatic adenocarcinoma, and 11% (11/98) of ≥ 5-year survivors. Nine patients had localized tumor and 2 metastatic disease at initial diagnosis. Disease progression occurred in 6 patients, and the local tumor bed was the most common site of progression. Six patients suffered from significant morbidities including recurrent cholangitis, second malignancy, malnutrition and bowel perforation. A rare subset of patients with pancreatic cancer achieve long-term survival without resection. Despite prolonged survival, morbidities unrelated to the primary cancer were frequently encountered and a close follow-up is warranted in these patients. Factors such as tumor biology and host immunity may play a key role in disease progression and survival.
Core tip: Five-year survival in patients with pancreatic cancer without curative resection is rare and has not been well described in the literature. At our institution from 1995 to 2009, non-resected ≥ 5-year survivors represented 2% (11/544) of all non-resected patients with pancreatic adenocarcinoma, and 11% (11/98) of ≥ 5-year survivors. These patients were mostly younger than 70 years of age, had excellent performance status and responded favorably to chemotherapy but suffered significant morbidities such as biliary sepsis. We speculate that tumor biology and host immunity play important roles on disease progression and survival.
