title: Long term survivors with metastatic pancreatic adenocarcinoma treated with gemcitabine: a retrospective analysis.
abstract: BACKGROUND
  Metastatic pancreatic adenocarcinoma has a short median overall survival (OS) of 5-6 months. However, a subgroup of patients survives more than 1 year. We analyzed the survival outcomes of this subgroup and evaluated clinical and pathological factors that might affect survival durations.
  
  
  METHODS
  We identified 20 patients with metastatic or recurrent pancreatic adenocarcinoma who received single-agent gemcitabine and had an OS longer than 1 year. Baseline data available after the diagnosis of metastatic or recurrent disease was categorized as: 1) clinical/demographic data (age, gender, ECOG PS, number and location of metastatic sites); 2) Laboratory data (Hematocrit, hemoglobin, glucose, LDH, renal and liver function and CA19-9); 3) Pathologic data (margins, nodal status and grade); 4) Outcomes data (OS, Time to Treatment Failure (TTF), and 2 year-OS). The lowest CA19-9 levels during treatment with gemcitabine were also recorded. We performed a univariate analysis with OS as the outcome variable.
  
  
  RESULTS
  Baseline logarithm of CA19-9 and total bilirubin had a significant impact on OS (HR = 1.32 and 1.31, respectively). Median OS and TTF on gemcitabine were 26.9 (95% CI = 18 to 32) and 11.5 (95% CI = 9.0 to 14.3) months, respectively. Two-year OS was 56.4%, with 7 patients alive at the time of analysis.
  
  
  CONCLUSIONS
  A subgroup of patients with metastatic pancreatic cancer has prolonged survival after treatment with gemcitabine. Only bilirubin and CA 19-9 levels were predictive of longer survival in this population. Further analysis of potential prognostic and predictive markers of response to treatment and survival are needed.
authors.affiliation: Division of Hematology/Oncology, Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. bhg@u.washington.edu
authors.forename: Bernardo H L
authors.initials: BH
authors.lastname: Goulart
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Clark
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: David P
authors.initials: DP
authors.lastname: Ryan
authors.forename: Nina
authors.initials: N
authors.lastname: Grenon
authors.forename: Alona
authors.initials: A
authors.lastname: Muzikansky
authors.forename: Andrew X
authors.initials: AX
authors.lastname: Zhu
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000534:rehabilitation*; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000534:rehabilitation*; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine