title: Higher overall survival in metastatic pancreatic cancer: the impact of where and how treatment is delivered.
abstract: OBJECTIVE
  To determine the overall survival of patients with advanced pancreatic cancer and evaluate factors that impact prognosis in a private cancer center.
  
  
  METHODS
  Data from the Hospital Cancer Registry at Hospital Israelita Albert Einstein were retrospectively collected. The patients enrolled had metastatic cancer at diagnosis or earlier staging and subsequent recurrence. Cases of neuroendocrine tumors were excluded.
  
  
  RESULTS
  A total of 65 patients were evaluated, including 63 with adenocarcinoma. The median overall survival for patients in all stages was 20.7 months (95%CI: 15.6-25.7), while the overall survival of metastatic disease was 13.3 months. Among the 33 cases with stage IV cancer, there was no evidence of a statistically significant association between median survival and CA19-9 dosage (p=0.212), tumor location (p=0.482), first treatment performed (p=0.337), lymphovascular invasion (p=0.286), and age (p=0.152). However, the number of lines of chemotherapy was significantly associated with survival (log-rank p=0.013), with an estimated median survival of 10.2 months for patients who received up to two lines of treatment and 23.5 months for those receiving more than two lines of chemotherapy.
  
  
  CONCLUSIONS
  The survival of patients treated was longer than that reported in the literature. The only statistically significant factor related to increased survival was higher number of lines of chemotherapy received. We believe that the higher socioeconomic status of patients surveyed in this study, as well as their greater access to treatment options, may have influenced their overall survival.
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Pedro Luiz Serrano
authors: PL
authors: Usón Junior
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Monique Sedlmaier
authors: MS
authors: França
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Heloisa Veasey
authors: HV
authors: Rodrigues
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Antônio Luiz de Vasconcellos
authors: AL
authors: Macedo
authors: Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors: Alberto
authors: A
authors: Goldenberg
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Oren
authors: O
authors: Smaletz
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Daniela Pezzutti Domingues
authors: DP
authors: Armentano
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Sergio Daniel
authors: SD
authors: Simon
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Rene Claudio
authors: RC
authors: Gansl
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000556:secondary; D000368:Aged; D001938:Brazil; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status / Q000706:statistics & numerical data; D008297:Male; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000556:secondary; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013997:Time Factors