Relationship between tumour size and outcome in pancreatic ductal adenocarcinoma.
BACKGROUND
The size of pancreatic ductal adenocarcinoma (PDAC) at diagnosis is an indicator of outcome. Previous studies have focused mostly on patients with resectable disease. The aim of this study was to investigate the relationship between tumour size and risk of metastasis and death in a large PDAC cohort, including all stages.


METHODS
Patients diagnosed with PDAC between 1988 and 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Tumour size was defined as the maximum dimension of the tumour as provided by the registry. Metastatic spread was assessed, and survival was calculated according to size of the primary tumour using the Kaplan-Meier method. Cox proportional regression modelling was used to adjust for known confounders.


RESULTS
Some 58 728 patients were included. There were 187 patients (0·3 per cent) with a tumour size of 0·5 cm or less, in whom the rate of distant metastasis was 30·6 per cent. The probability of tumour dissemination was associated with tumour size at the time of diagnosis. The association between survival and tumour size was linear for patients with localized tumours, but stochastic in patients with regional and distant stages. In patients with resected tumours, increasing tumour size was associated with worse tumour-specific survival, whereas size was not associated with survival in patients with unresected tumours. In the adjusted Cox regression analysis, the death rate increased by 4·1 per cent for each additional 1-cm increase in tumour size.


CONCLUSIONS
Pancreatic cancer has a high metastatic capacity even in small tumours. The prognostic impact of tumour size is restricted to patients with localized disease.
Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden.
D
D
Ansari
Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden.
M
M
Bauden
Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden.
S
S
Bergström
National Registry Centre, Skåne University Hospital, Lund University, Lund, Sweden.
R
R
Rylance
Department of Biomedical Engineering, Clinical Protein Science and Imaging, Lund University, Lund, Sweden.
G
G
Marko-Varga
Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden.
R
R
Andersson
D000230:Adenocarcinoma / Q000401:mortality*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis