10-year survival after resection of pancreatic ductal adenocarcinoma with pathological re-examination of a nationwide cohort

Abstract

Background Resection of pancreatic ductal adenocarcinoma (PDAC) is performed with curative intent, yet, long-term overall survival (OS) remains rare. This nationwide study assessed 10-year OS after resection of PDAC with diagnostic confirmation through pathological re-examination. Methods Patients were identified from the Netherlands Cancer Registry (NCR; 2000-2020). Kaplan-Meier survival analysis was performed to estimate the 10-year OS of the entire cohort, and for each of four consecutive 5-year periods to assess survival changes over time. Pathology data of patients who survived beyond 10 years was re-examined by two or more pancreatic pathologists. Results Among 5553 resected PDAC patients (2000-2020), estimated 10-year OS was 10.6 % with significant improvement across 5-year periods (P < 0.001). Actual 10-year OS after resection was reached by 179 patients (7.3 %). Review of available pathology reports (n = 173) revealed another diagnosis than PDAC (misregistration) in 21 patients (12.1 %). Of the remaining 152 patients, tissue could be retrieved for 108 patients (71.1 %), of whom 21 (19.4 %) had a different diagnosis after pathological re-examination (misclassification). Alternative diagnoses were benign (i.e., pancreatitis), premalignant (i.e., non-invasive IPMN), or other malignancies (i.e., distal cholangiocarcinoma, ampullary, duodenal, or acinar cell carcinoma). Of the 87 patients with confirmed PDAC, 12 patients (13.8 %) had a histological subtype other than conventional (classic) PDAC (e.g., adenosquamous or colloid carcinoma). After excluding the 42 misregistered or misclassified patients (24.3 %), the true observed 10-year OS after resection of PDAC was 5.3 %. Conclusion The observed 10-year OS after resection of PDAC in a nationwide cohort was only 5.3 % after pathological re-examination.