Clinical and pathological features of five-year survivors after pancreatectomy for pancreatic adenocarcinoma.

ABSTRACT

BACKGROUND: Clinical factors determining short-term survival after pancreatectomy have been well studied, but factors predicting long-term survival with curative resection are poorly understood in pancreatic carcinoma. Our objective was to identify clinical and pathological features of five-year disease-free survivors after surgical resection of pancreatic adenocarcinoma. METHODS: The clinical and pathological data from 147 patients who underwent a potentially curative resection for pancreatic adenocarcinoma at our institution between 1988 and 2012 were retrospectively analyzed. RESULTS: Of 147 patients, 18 survived for more than five years after surgery without disease recurrence. A univariate analyses demonstrated that two or fewer lymph node metastases (P=0.014), a preoperative serum carbohydrate antigen 19-9 (CA19-9) level of 40 U/mL or less (P=0.0018), an absence of intrapancreatic nerve invasion (P=0.028), and undergoing an R0 resection (P=0.011) were significantly associated with five-year survival. A logistic regression model identified the following independent cancer-related predictors of five-year survivors having two or fewer lymph node metastases (odds ratio (OR) 6.02; 95% confidence interval (CI) 1.08 to 112.98; P=0.0385), a preoperative serum CA19-9 level of 40 U/mL or less (OR 5.02; 95% CI 1.68 to 16.48; P=0.0036), and undergoing an R0 resection (OR 3.63; 95% CI 1.12 to 14.28; P=0.0316). CONCLUSIONS: We conclude that number of lymph node metastases being two or less, a preoperative serum CA19-9 level of 40 U/mL or less, and undergoing an R0 resection may be independent predictive factors to identify actual five-year survivors after pancreatectomy for pancreatic adenocarcinoma.