From the Guidelines
Pancreatic ductal adenocarcinoma has a poor prognosis, with a 5-year survival rate of only 2% for metastatic disease, as reported in the most recent study 1.
Prognosis and Survival Rates
The prognosis for pancreatic ductal adenocarcinoma is generally poor, with most patients being diagnosed at advanced stages.
- Median survival for metastatic disease is less than 1 year, with a 5-year overall survival rate of 2% 1.
- Early-stage disease that can be surgically removed offers the best chance for survival, with 5-year survival rates ranging from 10% to 20% following successful resection, and can be improved with adjuvant chemotherapy 1.
Factors Influencing Prognosis
Several factors influence the prognosis of pancreatic ductal adenocarcinoma, including:
- Tumor size
- Lymph node involvement
- Margin status after surgery
- CA19-9 tumor marker levels
Treatment Approaches
Treatment typically involves a multidisciplinary approach with:
- Surgery when possible, followed by adjuvant chemotherapy with regimens like FOLFIRINOX or gemcitabine plus nab-paclitaxel
- Chemotherapy and sometimes radiation for unresectable disease The use of adjuvant chemotherapy has been shown to more than double the 5-year survival rate in patients with resectable disease, from 10% with surgery alone to 25% with postoperative chemotherapy 1.
From the Research
Ductal Adenocarcinoma Pancreas Prognosis
- Pancreatic ductal adenocarcinoma is a cancer disease with a very poor prognosis, which poses the third-leading cause of cancer-related deaths and whose incidence and mortality have been predicted to increase significantly in the upcoming years 2.
- The survival rate for pancreatic cancer is sadly less than 8% 3.
- Distant metastatic PDAC is associated with the worst prognosis among the different phases of PDAC 4.
- Resectable patients are treated predominantly with surgery while borderline resectable patients may receive neoadjuvant treatment (NAT) to downstage their disease prior to possible resection 5.
- The high fatality rate is partly related to late diagnosis and partly to the aggressive nature of malignant cells that disseminate to nearby tissues at an early stage of the disease, making treatment difficult 3.
Treatment Options and Prognosis
- Available treatment choices consist of both medical and surgical: removal of the tumor, use of various medications like chemotherapeutic drugs and immunotherapeutic agents, radiation therapy, and targeted drug therapy 3.
- Drugs like Gemcitabine, Abraxane, FOLFIRINOX, and newer combination therapies are all effective in management, either curatively or palliatively 3.
- Gemcitabine/nab-paclitaxel (GN) and FOLFIRINOX are standard first-line treatment options for advanced pancreatic ductal adenocarcinoma (aPDAC) 6.
- In a comparative propensity score analysis, OS and PFS were highly similar between patients treated with GN and FOLFIRINOX 6.
Factors Affecting Prognosis
- Late diagnosis due to the prolonged clinically asymptomatic course of the disease, complicated anatomical localization, significant tumor heterogeneity, which makes it difficult to test new drugs and, last but not least, in the presence of dense tumor stroma, that complicates the access of cytostatics and targeted drugs into the tumor tissue 2.
- Tissue stiffness is associated with cancer progression, and another feature of PDAC is increased tissue heterogeneity 5.
- Tumour stiffness and heterogeneity may be used alongside currently employed diagnostics to better predict prognosis and response to treatment 5.