title: Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysis.
abstract: OBJECTIVE
  To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database.
  
  
  METHODS
  SEER database (2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases (liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailedPvalue < 0.05 was achieved.
  
  
  RESULTS
  A total of 13233 patients with stage IV pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases (for overall survival: lungvsliver metastases:P< 0.0001; distant nodalvsliver metastases:P< 0.0001) (for pancreatic cancer-specific survival: lungvsliver metastases:P< 0.0001; distant nodalvsliver metastases:P< 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.
  
  
  CONCLUSIONS
  Pancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Hani
authors.initials: H
authors.lastname: Oweira
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Ulf
authors.initials: U
authors.lastname: Petrausch
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Helbling
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Meinrad
authors.initials: M
authors.lastname: Mannhart
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Othmar
authors.initials: O
authors.lastname: Schöb
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Anwar
authors.initials: A
authors.lastname: Giryes
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Decker
authors.affiliation: Hani Oweira, Anwar Giryes, Omar Abdel-Rahman, Swiss Cancer Institute, 6330 Cham, Switzerland.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdel-Rahman
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary; D008175:Lung Neoplasms / Q000401:mortality* / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data*; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
keywords: Bone metastases; Liver metastases; Lung metastases; Pancreatic cancer; Surveillance Epidemiology and End Results database