Benjamin Kasenda, Annatina Bass, Dieter Koeberle, Bernhard Pestalozzi, Markus Borner, Richard Herrmann, Lorenz Jost, Andreas Lohri, Viviane Hess
Background Cancer registry data suggest that conditional survival prognosis in patients with aggressive malignancies improves over time. We investigated conditional survival in patients with advanced pancreatic cancer. Patients and Methods In this retrospective study, we included all patients with advanced pancreatic cancer treated at four Swiss hospitals between 1994 and 2004. Main outcome was 6-month conditional survival, defined as the probability of surviving an additional 6 months conditional on being alive at a certain time point. Further analyses included 6-month conditional survival stratified by CA 19-9 levels and Eastern Cooperative Oncology Group Performance Status. 6-month conditional survival results were compared to an open-access online calculator. We used the Kaplan-Meier method and a landmark analysis to calculate 6-month conditional survival. Results We included 483 patients; most with stage IV (81%). After a median follow-up of 9.1 months, 448 patients had died. At diagnosis, 6-month survival probability was 67% (95% CI, 63%-71%). For those patients still alive at 6, 12, 18, and 24 months after diagnosis respective 6-month conditional survival was 56% (95% CI; 50%-62%), 58% (95% CI, 51%-66%), 52% (95% CI, 43%-63%), and 71% (95% CI, 58%-85%). High CA 19-9 levels and low Eastern Cooperative Oncology Group Performance Status at diagnosis were significantly associated with inferior survival, but did not affect 6-month conditional survival over time. Conclusion In contrast to previous reports and to a registry based calculator, 6-month conditional survival remains stable and above 50% for the first 2 years after diagnosis. Our results provide important information for counselling patients with advanced pancreatic cancer during treatment and follow-up.
