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Postoperative Conditional Survival Matrix for Resected Pancreatic Adenocarcinoma
*Timothy L Fitzgerald1, *Lucas Hunter2, Dougald C MacGillivary1, *Catalina Mosquera2, *Jimmy Efird2
1Tufts University Medical Center Maine Medical Center, Portland, ME;2East Carolina University, Greenville, NC

Objective: By accounting for time already survived, conditional survival provides a more accurate measure of future survival than conventional estimates. Examination of outcomes after successful pancreatectomy for pancreatic adenocarcinoma allows a better understanding of the long-term survival.
Design: Cohort
Setting: Commission on Cancer certified cancer hospitals.
Intervention: Pancreatic resection for adenocarcinoma
Main Outcome Measure: 90-day conditional survival
Patients: Patients diagnosed with pancreatic adenocarcinoma, from 2004 through 2012, identified from the NCDB, were included. Data were utilized to construct a postoperative conditional risk-stratified matrix that included histopathologic factors and adjuvant therapy for those who survive 90 days beyond surgery.
Results: A total of 44,560 patients (51% male, 54% >65 years of age) presented with pancreatic cancer. A majority of patients had tumors > 2cm size (76%), grade I/II (65%), and lymphovascular invasion (63%). There was an association between all factors and adjuvant therapy with three and five-year survival on univariate and multivariate analysis. The figure represents the risk matrix for patientsí ≤65 years of age. As an example, patient, with early stage cancer (Size ≤2cm, Grade I/II, - LN, - Margins) that received adjuvant therapy had a 62% probability of surviving beyond three years (95% CI=61%-64%). In comparison, if adjuvant treatment was not received, this patientís conditional survival probability decreased to 51% (95% CI=50%-53%).
Conclusions: These results provide surgeons and their patients with more accurate information regarding long-term survival, as well as the benefit of adjuvant therapy for all patients after successful pancreatic resection.


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