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Relationship between tumour size and outcome in pancreatic ductal adenocarcinoma

Ansari, D. LU ; Bauden, M. LU ; Bergström, S. LU ; Rylance, R. LU ; Marko-Varga, G. LU and Andersson, R. LU (2017) In British Journal of Surgery 104(5). p.600-607
Abstract

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... (More)

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 58728 patients were included. There were 187 patients (0·3 per cent) with a tumour size of 0·5cm 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. Conclusion: Pancreatic cancer has a high metastatic capacity even in small tumours. The prognostic impact of tumour size is restricted to patients with localized disease.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
tumor size, pancreatic ductal adenocarcinoma
in
British Journal of Surgery
volume
104
issue
5
pages
600 - 607
publisher
John Wiley & Sons
external identifiers
  • scopus:85012098033
  • pmid: 28177521
  • wos:000397510400013
ISSN
0007-1323
DOI
10.1002/bjs.10471
language
English
LU publication?
yes
id
41ee3b39-dc8d-4b0d-9e2c-e1534da7d4dc
date added to LUP
2017-03-03 12:04:22
date last changed
2018-04-15 04:41:44
@article{41ee3b39-dc8d-4b0d-9e2c-e1534da7d4dc,
  abstract     = {<p>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 58728 patients were included. There were 187 patients (0·3 per cent) with a tumour size of 0·5cm 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. Conclusion: Pancreatic cancer has a high metastatic capacity even in small tumours. The prognostic impact of tumour size is restricted to patients with localized disease.</p>},
  author       = {Ansari, D. and Bauden, M. and Bergström, S. and Rylance, R. and Marko-Varga, G. and Andersson, R.},
  issn         = {0007-1323},
  keyword      = {tumor size,pancreatic ductal adenocarcinoma  },
  language     = {eng},
  number       = {5},
  pages        = {600--607},
  publisher    = {John Wiley & Sons},
  series       = {British Journal of Surgery},
  title        = {Relationship between tumour size and outcome in pancreatic ductal adenocarcinoma},
  url          = {http://dx.doi.org/10.1002/bjs.10471},
  volume       = {104},
  year         = {2017},
}