Morbidity and mortality in patients with stage IV pancreatic adenocarcinoma and acute cholangitis: Outcomes and risk prognostication Journal Article
| Authors: | Singh, I.; Chou, J. F.; Capanu, M.; Park, J.; Yu, K. H.; Varghese, A. M.; Park, W.; Zervoudakis, A.; Keane, F.; Rolston, V. S.; Gerdes, H.; Wei, A. C.; Shah, P.; Covey, A.; Schattner, M.; O'Reilly, E. M. |
| Article Title: | Morbidity and mortality in patients with stage IV pancreatic adenocarcinoma and acute cholangitis: Outcomes and risk prognostication |
| Abstract: | Background: Acute cholangitis (AC) is a common complication of pancreatic ductal adenocarcinoma (PDAC). Herein, we evaluated outcomes after the first AC episode and predictors of mortality and AC recurrence in patients with stage IV PDAC. Methods: We conducted a single-center, retrospective observational study using institutional databases. Clinical data and outcomes for patients with stage IV PDAC and at least one documented episode of AC, were assessed. Overall survival (OS) was estimated using the Kaplan-Meier method, and Cox regression model was employed to identify predictors of AC recurrence and mortality. Results: One hundred and twenty-four patients with stage IV PDAC and AC identified between January 01, 2014 and October 31, 2020 were included. Median OS after first episode of AC was 4.1 months (95 % CI, 4.0–5.5), and 30-day, 6, and 12-month survival was 86.2 % (95 % CI, 80.3–92.5), 37 % (95 % CI, 29.3–46.6 %) and 18.9 % (95 % CI, 13.1–27.3 %), respectively. Primary tumor in pancreatic body/tail (HR 2.29, 95 % CI: 1.26 to 4.18, p = 0.011), concomitant metastases to liver and other sites (HR 1.96, 95 % CI: 1.16 to 3.31, p = 0.003) and grade 3 AC (HR 2.26, 95 % CI: 1.45 to 3.52, p < 0.001), predicted worse outcomes. Intensive care unit admission, sepsis, systemic therapy, treatment regimen, and time to intervention did not predict survival or risk of recurrence of AC. Conclusions: AC confers significant morbidity and mortality in advanced PDAC. Worse outcomes are associated with higher grade AC, primary tumor location in pancreatic body/tail, and metastases to liver and other sites. © 2024 The Authors |
| Keywords: | adult; cancer survival; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; overall survival; mortality; cancer recurrence; systemic therapy; gemcitabine; paclitaxel; cancer patient; pancreatic neoplasms; cancer staging; recurrence risk; neoplasm staging; adenocarcinoma; morbidity; carcinoma, pancreatic ductal; cohort analysis; risk factors; pathology; retrospective study; risk factor; cancer mortality; intensive care unit; liver metastasis; pancreas tumor; pancreas adenocarcinoma; sepsis; hospital admission; pancreatic cancer; observational study; acute disease; complication; clinical outcome; pancreatic ductal carcinoma; yttrium 90; stage iv; cancer prognosis; cholangitis; very elderly; humans; prognosis; human; male; female; article; beta lactam antibiotic; endoscopic retrograde cholangiopancreatography (ercp); self-expanding metallic stents (sems) |
| Journal Title: | Pancreatology |
| Volume: | 24 |
| Issue: | 4 |
| ISSN: | 1424-3903 |
| Publisher: | Karger |
| Date Published: | 2024-06-01 |
| Start Page: | 608 |
| End Page: | 615 |
| Language: | English |
| DOI: | 10.1016/j.pan.2024.05.515 |
| PUBMED: | 38749803 |
| PROVIDER: | scopus |
| PMCID: | PMC11164623 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Eileen M. O'Reilly -- Source: Scopus |
