title: Five-Year Actual Overall Survival in Resected Pancreatic Cancer: A Contemporary Single-Institution Experience from a Multidisciplinary Perspective.
abstract: BACKGROUND
  Successful surgical resection combined with effective perioperative therapy is essential for maximizing long-term survival for pancreatic adenocarcinoma.
  
  
  METHODS
  All patients with pancreatic adenocarcinoma who underwent curative resection at our institution from January 2003 to May 2010 were reviewed. Demographic and clinical details were retrospectively collected from medical records and cancer registry data.
  
  
  RESULTS
  Overall, 176 patients were included in the analysis (148 with de novo resectable disease and 28 with borderline resectable disease at presentation). Among 106 patients who received all perioperative therapy at our institution, 94% received neoadjuvant and/or adjuvant treatment in addition to resection. Actual all-cause 5-year overall survival (OS) for all 176 patients was 30.7%, with a median OS of 33.9 months [95% confidence interval (CI) 28.1-39.6 months]. For patients who received all perioperative therapy at our institution, actual all-cause 5-year disease-free survival (DFS) was 32.1%, with a median DFS of 28.8 months (95% CI 20.1-43.6 months). Of these patients, 67/106 (63%) recurred: 8 (8%) locoregional only; 52 (49%) systemic only; and 7 (7%) combined recurrence. No difference in survival rates or recurrence patterns was seen between resectable and borderline resectable patients. In multivariate analysis, tumor differentiation (poor vs. non-poor) and lymph node ratio >20% produced a useful clinical model.
  
  
  CONCLUSIONS
  The actual OS rates for resected pancreatic cancer shown in this study are reflective of those currently achievable at a tertiary medical center dedicated to this patient population. In considering these results, both frequency and type of adjuvant/neoadjuvant therapy administered in the context of the clinical experience/management techniques of providers administering these treatments will be discussed.
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA. hemvjp@vmmc.org.|Cancer Institute, Virginia Mason Medical Center, Seattle, WA, USA. hemvjp@vmmc.org.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Picozzi
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Cancer Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Margaret T
authors.initials: MT
authors.lastname: Mandelson
authors.affiliation: Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Russell
authors.initials: R
authors.lastname: Dorer
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Flavio G
authors.initials: FG
authors.lastname: Rocha
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Alseidi
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Biehl
authors.affiliation: Center for Pancreatic Disease and Mountain States Tumor Institute, Boise, ID, USA.
authors.forename: L William
authors.initials: LW
authors.lastname: Traverso
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Helton
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D010180:Pancreatectomy / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate