Background: Pancreatic ductal adenocarcinoma (PDAC) commonly has late presentation and poorer outcomes associated with this. A recent Lancet Oncology registry-based study identified WA as having the global best survival for cancers of pancreas, colon, and stomach. The 5 year-survival (5YS) in Australia is approximately 12.6%, which includes early-stage disease as well as locally advanced and metastatic. The global 5YS is slightly worse at <10%, with metastatic 5YS being 3%. We evaluated factors contributing to survival and wish to report updated data
Methods: We conducted a prospective cohort study with all patients treated for PDAC at our institution between April 2008 and June 2024. All patients had an ECOG performance status of 2 or less prior to starting treatment. Overall survival (OS) was calculated via Kaplan-Meier method
Results: There were 355 patients identified in our cohort. Of these, at diagnosis 174 patients were metastatic and 181 patients had locally advanced disease. The median age of patients at diagnosis was 66 years (range, 25-87 years). The treatment modalities varied widely. Overall 175 patients were treated with chemotherapy alone, 88 patients had chemo-radiotherapy, 1 patient received Cyberknife RT alone, 42 patients had chemotherapy and surgery and 50 patients had trimodality treatment. Across the groups who received chemotherapy, 152 received mFOLFIRINOX as second-line and 64 received gemcitabine with nab-paclitaxel as third-line retreatment. The combined OS was 21 months [95% CI, 18.5-23.5]. In the metastatic group OS was 22 months (95% CI, 18.5-25.5) and in the non-metastatic group OS was 33 months (95% CI, 29-37). 5YS overall was 13.1%, with metastatic 5YS was 3.25% and non-metastatic was 21.5% respectively
Conclusion: This analysis shows a significant prolonged OS for patients with locally advanced and metastatic disease. Factors identified as hypothesis of improved outcomes as demonstrated with the use of second-line mFOLFIRINOX, as well as third-line retreatment with gemcitabine and nab-paclitaxel