title: Pancreatic ductal adenocarcinoma: long-term survival does not equal cure.
abstract: BACKGROUND
  Pancreatic ductal adenocarcinoma represents 90% of pancreatic cancers and is an important cause of cancer death in the United States. Operative resection remains as the only treatment providing prolonged survival, but even after a curative resection, 5-year survival rates are low. Our aim was to identify the prognostic factors for long-term survival after resection of pancreatic ductal adenocarcinoma related to patients, treatments, and tumor biology.
  
  
  METHODS
  Retrospective review identified 959 patients who underwent resection of their pancreatic adenocarcinoma between February 1985 and December 2010, of whom 499 were resected before November 2006 and represent the cohort we describe in this study. Patient, tumor, and treatment-related variables were assessed for their associations with 5- and 10-year overall survival.
  
  
  RESULTS
  Of the 499 patients, 49% were female and median age was 65 years. The majority of patients had stage IIb disease (60%). Actual 5-year survival after resection of pancreatic adenocarcinoma was 19% (95/499), and actual 10-year survival was 10% (33/329). Significant clinicopathologic factors predicting 5- and 10-year survival were negative margins and negative nodal status. Interestingly, 41% (39/95) of long-term survivors had positive nodes and 24% (23/95) had positive margins.
  
  
  CONCLUSIONS
  Pancreatic ductal adenocarcinoma demonstrates a very heterogeneous biology, but patients with negative resection margins and node negative cancers are more likely to survive 5 years after resection. However, our series demonstrates that the biology of the cancer rather than simple pathologic factors determine a patient's prognosis.
authors: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. cferrone@partners.org
authors: Cristina R
authors: CR
authors: Ferrone
authors: Rafael
authors: R
authors: Pieretti-Vanmarcke
authors: Jordan P
authors: JP
authors: Bloom
authors: Hui
authors: H
authors: Zheng
authors: Jackye
authors: J
authors: Szymonifka
authors: Jennifer A
authors: JA
authors: Wargo
authors: Sarah P
authors: SP
authors: Thayer
authors: Gregory Y
authors: GY
authors: Lauwers
authors: Vikram
authors: V
authors: Deshpande
authors: Mari
authors: M
authors: Mino-Kenudson
authors: Carlos
authors: C
authors: Fernández-del Castillo
authors: Keith D
authors: KD
authors: Lillemoe
authors: Andrew L
authors: AL
authors: Warshaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D015996:Survival Rate