Unraveling the oligometastatic phenotype and its association with pancreatic cancer survival.

Authors

John Karalis

John D Karalis

University of Texas Southwestern Medical Center, Dallas, TX

John D Karalis , Ahmed Elamir , Gilbert Zvikomborero Murimwa , Sebastian Enrico , Kishore Balasubramanian , Megan Wachsmann , Zhikai Chi , Todd Anthony Aguilera , Patricio Polanco , Matteo Ligorio

Organizations

University of Texas Southwestern Medical Center, Dallas, TX, University of Texas Southwestern, Dallas, TX, University of South Florida Morsani College of Medicine, Tampa, FL, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX

Research Funding

U.S. National Institutes of Health

Background: Stage IV pancreatic ductal adenocarcinoma (PDAC) carries a dismal prognosis with a reported five-year survival of 2%. While treated as a monolithic population, a subset of stage IV patients exhibit a superior response to chemotherapy. In fact, anecdotal studies have shown that a well-selected subset of patients with oligometastatic disease of the liver and/or lung may benefit from more aggressive locoregional therapies. However, the definitions of oligometastatic disease utilized are arbitrary and exhibit a high degree of inter-study variation. In this study, we aim to advance a data-based definition of oligometastatic disease to support novel therapeutic approaches. Methods: Our institutional cancer registry was queried to identify consecutive patients diagnosed with pathologically confirmed stage IV PDAC (2015-2019). Pre-treatment cross-sectional imaging was reviewed and up to 10 liver and/or lung metastases were quantified while > 10 metastases was considered innumerable. Metastases to the peritoneum, bone, non-regional lymph nodes and other distant metastatic sites were recorded. A multivariable Cox regression model was used to assess the association of the number of isolated liver and/or lung metastases with overall survival (OS). Using time-dependent receiver operative characteristic (t-ROC) curves, we evaluated all of the subjects with isolated liver/lung metastasis for each cut-off (1-10) to identify the threshold most capable of predicting OS. Kaplan-Meier curves were used to visualize the patient survival function and the log-rank test was applied to test the statistical significance. Results: 183 patients with complete pre-treatment cross-sectional imaging available for review were included in this retrospective study. Amongst them, only 167 patients had complete treatment records and were included in the final multivariable analysis. 43% (72/167) of patients were treated with FOLFIRINOX, 38% (63/167) with gemcitabine/nab-paclitaxel, and 19% (32/167) elected best supportive care. Patients with ≤5 isolated liver/lung metastases had improved OS compared to patients with > 5 liver/lung metastases and/or other sites of distant metastasis (HR 0.48, 95% CI: 0.32, 0.76; p = 0.001). t-ROC analysis showed that a cut-off of ≤5 isolated liver/lung metastases was most predictive of survival at 12 (AUC 0.77) and 18 months (AUC 0.78) after diagnosis. Median OS of patients with ≤5 liver and/or lung metastases (n = 32) and > 5 liver/lung metastases and/or additional sites of metastasis (n = 135) was 13.7 vs. 5.8 months, respectively (p = 0.0004). Conclusions: In this study, we propose an anatomically-based definition of oligometastatic disease for stage IV PDAC patients. Our data showed that patients with ≤5 isolated liver/lung metastases have a more favorable prognosis and may benefit from early consideration of multimodal therapy intensification.

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Abstract Details

Meeting

2022 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Track

Pancreatic Cancer,Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Small Bowel Cancer

Sub Track

Other

DOI

10.1200/JCO.2022.40.4_suppl.618

Abstract #

618

Poster Bd #

Online Only

Abstract Disclosures