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Impact of Prior Malignancy on Survival Outcomes of Stage IV Pancreatic Adenocarcinoma: SEER-Based Cohort

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Abstract

Purpose

Pancreatic cancer is one of the most fatal malignancies and the fourth leading cause of cancer-related mortality in the USA. Most clinical trials involving pancreatic adenocarcinoma (PAC) patients exclude subjects with a prior malignancy because of the possible effect of prior malignancies on survival. However, no data in the medical literature support this assumption. In this paper, we aim to study the impact of having a prior malignancy on the survival outcomes of stage IV PAC.

Methods

We used the surveillance, epidemiology, and end results database to review patients with stage IV PAC diagnosed between 1973 and 2014. We calculated overall and pancreatic cancer-specific survival of these patients using unadjusted Kaplan-Meier test and multivariable covariate-adjusted Cox models.

Results

We reviewed 66,874 stage IV PAC patients, of which 4942 had a prior malignancy. Kaplan-Meier and Cox models showed that a history of prior malignancy did not cause significant difference in overall survival (HR = 0.938, 95%CI = 0.880–1.000, p = .052). However, a prior malignancy was associated with a better pancreatic cancer-specific survival (HR = 0.855, 95% CI = 0.796–0.918, p < .001).

Conclusion

A prior malignancy before stage IV PAC was not associated with worse survival outcomes. Researchers should take these results into consideration when including/excluding patients to improve the generalizability and accuracy of their results.

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Acknowledgments

We would like to thank Saad L. Janoudi for his help in data preparation and statistical analysis.

Role of Authors

All authors participated in designing the concept of the paper. AS and MA conducted the analysis of the data and had the access to the database. All authors have contributed to data interpretation and writing the paper. All authors have revised and agreed to the content of the paper. OA supervised the whole project scientifically and had final responsibility for the decision to submit for publication. MA managed and coordinated the research activity planning and execution.

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Author notes

  1. Muneer J. Al-Husseini and Anas M. Saad contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Muneer J. Al-Husseini, Anas M. Saad & Mohamed A. Tabash

  2. Faculty of Medicine, Damascus University, Damascus, Syria

    Tarek Turk

  3. Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, 11566, Egypt

    Omar Abdel-Rahman

  4. Department of Oncology, University of Calgary and Tom Baker Cancer Center, Calgary, AB, Canada

    Omar Abdel-Rahman

Authors
  1. Muneer J. Al-Husseini
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  2. Anas M. Saad
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  3. Tarek Turk
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  4. Mohamed A. Tabash
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  5. Omar Abdel-Rahman
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Corresponding author

Correspondence to Omar Abdel-Rahman.

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The authors declare that they have no conflict of interest.

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Al-Husseini, M.J., Saad, A.M., Turk, T. et al. Impact of Prior Malignancy on Survival Outcomes of Stage IV Pancreatic Adenocarcinoma: SEER-Based Cohort. J Gastrointest Canc 50, 794–800 (2019). https://doi.org/10.1007/s12029-018-0158-4

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  • DOI: https://doi.org/10.1007/s12029-018-0158-4

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