title: Comparative outcomes between initially unresectable and recurrent cases of advanced pancreatic cancer following palliative chemotherapy.
abstract: OBJECTIVE
  The objective of this study was to compare the clinical outcomes between initially unresectable and recurrent advanced pancreatic cancer (APC) patients after palliative chemotherapy.
  
  
  METHODS
  Data of a total of consecutive 269 patients with pathologically confirmed APC patients who received palliative chemotherapy between January 2006 and April 2012 were reviewed. Patients were classified into initially unresectable and recurrent group, and overall survival (OS) was compared between the 2 groups.
  
  
  RESULTS
  The median OS was significantly longer in the recurrent group compared with the initially unresectable group (383 vs 308 days; hazard ratio [HR], 0.59; 95% confidence interval, 0.44-0.80; P < 0.01). After adjustment for distant metastasis, performance status, and levels of carbohydrate antigen 19-9, carcinoembryonic antigen, C-reactive protein, and lactate dehydrogenase, the status of recurrent or unresectable disease remained as an independent prognostic factor with a clinically relevant HR value (HR, 0.66; 95% confidence interval, 0.48-0.90; P = 0.01). In addition, the 2-year OS rate of the recurrent group was significantly higher than that of the unresectable group (24.2% vs 9.6%, P = 0.01).
  
  
  CONCLUSIONS
  Our results suggested that the status of recurrent or initially unresectable disease was an independent prognostic factor in APC patients receiving palliative chemotherapy.
authors.affiliation: From the *Outpatient Oncology Unit, †Department of Gastroenterology and Hepatology, and ‡Department of Surgery, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Peng
authors.initials: P
authors.lastname: Xue
authors.forename: Masashi
authors.initials: M
authors.lastname: Kanai
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mori
authors.forename: Takafumi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Uza
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Kodama
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Takaori
authors.forename: Shigemi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D018395:CA-19-9 Antigen / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase