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Morbidity and mortality in patients with stage IV pancreatic adenocarcinoma and acute cholangitis: Outcomes and risk prognostication.
Singh, Isha; Chou, Joanne F; Capanu, Marinela; Park, Jennifer; Yu, Kenneth H; Varghese, Anna M; Park, Wungki; Zervoudakis, Alice; Keane, Fergus; Rolston, Vineet Syan; Gerdes, Hans; Wei, Alice C; Shah, Pari; Covey, Anne; Schattner, Mark; O'Reilly, Eileen M.
Afiliação
  • Singh I; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, 26505, USA.
  • Chou JF; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
  • Capanu M; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
  • Park J; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
  • Yu KH; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
  • Varghese AM; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
  • Park W; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
  • Zervoudakis A; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
  • Keane F; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
  • Rolston VS; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
  • Gerdes H; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
  • Wei AC; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
  • Shah P; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
  • Covey A; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
  • Schattner M; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
  • O'Reilly EM; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; David M. Rubenstein Center for Pancreas Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA. Electronic address:
Pancreatology ; 24(4): 608-615, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38749803
ABSTRACT

BACKGROUND:

Acute cholangitis (AC) is a common complication of pancreatic ductal adenocarcinoma (PDAC). Herein, we evaluated outcomes after the first AC episode and predictors of mortality and AC recurrence in patients with stage IV PDAC.

METHODS:

We conducted a single-center, retrospective observational study using institutional databases. Clinical data and outcomes for patients with stage IV PDAC and at least one documented episode of AC, were assessed. Overall survival (OS) was estimated using the Kaplan-Meier method, and Cox regression model was employed to identify predictors of AC recurrence and mortality.

RESULTS:

One hundred and twenty-four patients with stage IV PDAC and AC identified between January 01, 2014 and October 31, 2020 were included. Median OS after first episode of AC was 4.1 months (95 % CI, 4.0-5.5), and 30-day, 6, and 12-month survival was 86.2 % (95 % CI, 80.3-92.5), 37 % (95 % CI, 29.3-46.6 %) and 18.9 % (95 % CI, 13.1-27.3 %), respectively. Primary tumor in pancreatic body/tail (HR 2.29, 95 % CI 1.26 to 4.18, p = 0.011), concomitant metastases to liver and other sites (HR 1.96, 95 % CI 1.16 to 3.31, p = 0.003) and grade 3 AC (HR 2.26, 95 % CI 1.45 to 3.52, p < 0.001), predicted worse outcomes. Intensive care unit admission, sepsis, systemic therapy, treatment regimen, and time to intervention did not predict survival or risk of recurrence of AC.

CONCLUSIONS:

AC confers significant morbidity and mortality in advanced PDAC. Worse outcomes are associated with higher grade AC, primary tumor location in pancreatic body/tail, and metastases to liver and other sites.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Colangite Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Pancreatology Assunto da revista: ENDOCRINOLOGIA / GASTROENTEROLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Colangite Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Pancreatology Assunto da revista: ENDOCRINOLOGIA / GASTROENTEROLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos