Abstract：
OBJECTIVE: The aim of this study was to determine the role of site-specific metastatic patterns over time and assess factors associated with extended survival in metastatic PDAC. Half of all patients with pancreatic ductal adenocarcinoma (PDAC) present with metastatic disease. The site of metastasis plays a crucial role in clinical decision making due to its prognostic value.
METHODS: We examined 56,757 stage-IV PDAC patients from the National Cancer Database (2016-2019), categorizing them by metastatic site: multiple, liver, lung, brain, bone, carcinomatosis, or other. The site-specific prognostic value was assessed using log-rank tests while time-varying effects were assessed by Aalen\'s linear hazards model. Factors associated with extended survival (>3years) were assessed with logistic regression.
RESULTS: Median overall survival (mOS) in patients with distant lymph node-only metastases (9.0 months) and lung-only metastases (8.1 months) was significantly longer than in patients with liver-only metastases (4.6 months, p < 0.001). However, after six months, the metastatic site lost prognostic value. Logistic regression identified extended survivors (3.6 %) as more likely to be younger, Hispanic, privately insured, Charlson-index <2, having received chemotherapy, or having undergone primary or distant site surgery (all p < 0.001).
CONCLUSIONS: While synchronous liver metastases are associated with worse outcomes than lung-only and lymph node-only metastases, this predictive value is diminished after six months. Therefore, treatment decisions beyond this time should not primarily depend on the metastatic site. Extended survival is possible in a small subset of patients with favorable tumor biology and good conditional status, who are more likely to undergo aggressive therapies.
METHODS: We examined 56,757 stage-IV PDAC patients from the National Cancer Database (2016-2019), categorizing them by metastatic site: multiple, liver, lung, brain, bone, carcinomatosis, or other. The site-specific prognostic value was assessed using log-rank tests while time-varying effects were assessed by Aalen\'s linear hazards model. Factors associated with extended survival (>3years) were assessed with logistic regression.
RESULTS: Median overall survival (mOS) in patients with distant lymph node-only metastases (9.0 months) and lung-only metastases (8.1 months) was significantly longer than in patients with liver-only metastases (4.6 months, p < 0.001). However, after six months, the metastatic site lost prognostic value. Logistic regression identified extended survivors (3.6 %) as more likely to be younger, Hispanic, privately insured, Charlson-index <2, having received chemotherapy, or having undergone primary or distant site surgery (all p < 0.001).
CONCLUSIONS: While synchronous liver metastases are associated with worse outcomes than lung-only and lymph node-only metastases, this predictive value is diminished after six months. Therefore, treatment decisions beyond this time should not primarily depend on the metastatic site. Extended survival is possible in a small subset of patients with favorable tumor biology and good conditional status, who are more likely to undergo aggressive therapies.
摘要：
目的：本研究的目的是确定特定部位转移模式随时间的作用，并评估与转移性PDAC的延长生存期相关的因素。所有胰腺导管腺癌（PDAC）患者中有一半患有转移性疾病。由于其预后价值，转移部位在临床决策中起着至关重要的作用。
方法：我们从国家癌症数据库（2016-2019）检查了56,757例IV期PDAC患者，按转移部位分类：多个，肝脏,肺，大脑,骨头,癌,或其他。使用对数秩检验评估特定地点的预后价值，同时通过Aalen的线性风险模型评估随时间变化的影响。用逻辑回归分析评估与延长生存期（>3年）相关的因素。
结果：仅有远处淋巴结转移（9.0个月）和仅有肺转移（8.1个月）的患者的中位总生存期（mOS）明显长于仅有肝转移（4.6个月，p<0.001)。然而,六个月后，转移部位失去预后价值。Logistic回归确定延长的幸存者(3.6%)更有可能更年轻，西班牙裔,私人保险，Charlson指数<2，接受过化疗，或曾接受过原发性或远处手术(所有p<0.001)。
结论：虽然同步肝转移比仅肺转移和仅淋巴结转移更差的预后相关，该预测值在6个月后降低.因此,超过此时间的治疗决定不应主要取决于转移部位。在一小部分具有良好肿瘤生物学和良好条件状态的患者中，延长生存期是可能的。他们更有可能接受积极的治疗。
方法：我们从国家癌症数据库（2016-2019）检查了56,757例IV期PDAC患者，按转移部位分类：多个，肝脏,肺，大脑,骨头,癌,或其他。使用对数秩检验评估特定地点的预后价值，同时通过Aalen的线性风险模型评估随时间变化的影响。用逻辑回归分析评估与延长生存期（>3年）相关的因素。
结果：仅有远处淋巴结转移（9.0个月）和仅有肺转移（8.1个月）的患者的中位总生存期（mOS）明显长于仅有肝转移（4.6个月，p<0.001)。然而,六个月后，转移部位失去预后价值。Logistic回归确定延长的幸存者(3.6%)更有可能更年轻，西班牙裔,私人保险，Charlson指数<2，接受过化疗，或曾接受过原发性或远处手术(所有p<0.001)。
结论：虽然同步肝转移比仅肺转移和仅淋巴结转移更差的预后相关，该预测值在6个月后降低.因此,超过此时间的治疗决定不应主要取决于转移部位。在一小部分具有良好肿瘤生物学和良好条件状态的患者中，延长生存期是可能的。他们更有可能接受积极的治疗。
