title: Histologic Tumor Grade and Preoperative Bilary Drainage are the Unique Independent Prognostic Factors of Survival in Pancreatic Ductal Adenocarcinoma Patients After Pancreaticoduodenectomy.
abstract: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal types of cancer; most patients die during the first 6 months after diagnosis. With a 5% 5-year survival rate, is the fourth leading cause of cancer death in developed countries. In this regard, several clinical, histopathologic and biological characteristics of the disease favoring long-term survival after pancreaticoduodenectomy have been reported to be significant prognostic factors. Despite the availability of this information, there is no consensus about the different prognostic factors reported in the literature, probably due to variations in patient selection, methods, and sample size studied. The aim of this study was to identify the clinical and pathologic features associated to prognosis of the disease after pancreaticoduodenectomy.
  
  
  
  The clinical and pathologic data from 78 patients who underwent a potentially curative resection for PDAC at our institution between 2003 and 2014 were analyzed retrospectively.
  
  
  
  Overall, high-grade PDAC cases showed larger tumor size (P=0.009) and a higher frequency of deaths in association with a nonsignificantly shortened patient overall survival (median of 12.5 vs. 21.7 mo; P=0.065) as compared with low-grade PDAC patients. High histologic grade (P=0.013), preoperative drainage on the main bile duct (P=0.014) and absence of adjuvant therapy (P=0.035) were associated with a significantly poorer outcome. Overall survival multivariate analysis showed histologic grade (P=0.019) and bile duct preoperative drainage (P=0.016) as the sole independent variables predicting an adverse outcome.
  
  
  
  Our results indicate that histologic tumor grade and preoperative biliary drainage are the only significant independent prognostic factors in PDAC patients after pancreatectomy.
authors.affiliation: Service of General and Gastrointestinal Surgery and IBSAL.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Macías
authors.affiliation: Department of Medicine, Cytometry Service-Nucleus, Cancer Research Center (IBMCC-CSIC/USAL) and IBSAL, University of Salamanca, Salamanca, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Sayagués
authors.affiliation: Service of General and Gastrointestinal Surgery and IBSAL.
authors.forename: Carmen
authors.initials: C
authors.lastname: Esteban
authors.affiliation: Service of General and Gastrointestinal Surgery and IBSAL.
authors.forename: Manuel
authors.initials: M
authors.lastname: Iglesias
authors.affiliation: Service of General and Gastrointestinal Surgery and IBSAL.
authors.forename: Luís M
authors.initials: LM
authors.lastname: González
authors.affiliation: Service of General and Gastrointestinal Surgery and IBSAL.
authors.forename: Jose
authors.initials: J
authors.lastname: Quiñones-Sampedro
authors.affiliation: Department of Medicine, Cytometry Service-Nucleus, Cancer Research Center (IBMCC-CSIC/USAL) and IBSAL, University of Salamanca, Salamanca, Spain.
authors.forename: María L
authors.initials: ML
authors.lastname: Gutiérrez
authors.affiliation: Cáncer Research Center and Service of Hematology.
authors.forename: Luís A
authors.initials: LA
authors.lastname: Corchete
authors.affiliation: Department of Pathology and IBSAL, University Hospital of Salamanca.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Abad
authors.affiliation: Department of Pathology and IBSAL, University Hospital of Salamanca.
authors.forename: Oscar
authors.initials: O
authors.lastname: Bengoechea
authors.affiliation: Service of General and Gastrointestinal Surgery and IBSAL.
authors.forename: Luís
authors.initials: L
authors.lastname: Muñoz-Bellvis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome