Outcomes and prognostic factors of resected pancreatic ductal adenocarcinoma in Saudi Arabia

Pancreatic ductal adenocarcinoma, which comprises the majority of pancreatic cancers, is associated with poor survival. There are no local data describing the outcomes of resected pancreatic adenocarcinoma in Saudi Arabia. We aimed to study the clinical and pathological features and the treatment outcomes related to resected pancreatic cancer in Saudi Arabia.

A multi-center retrospective study was conducted with data of eligible cases from the last five years were collected from six oncology centers across Saudi Arabia. Survival, adjuvant chemotherapy regimens, and variables such as intraoperative blood loss, neutrophil to lymphocyte ratio (NLR) and other potential prognostic variables were collected. Chi-square test was used to compare the categorical variables between the two groups (patients with better and worse overall survival).

The study included total of 180 patients of which 69% were males. Median age was 62 years (range 34-90), and mean body mass index was 26.7 kg/m2. Only 4% were asymptomatic at presentation, while the most common symptom at presentation was jaundice affecting 77% of patients. The most common location of primary tumor was in the head of the pancreas in 58% of all cases, and 44% were staged as IIB at diagnosis, followed by 33% who were stage IIA, and finally 16.5% who were at stage III. Median overall survival for the full cohort was 23.8 months (range 4-89), and 75% of patients were alive at one year whereas only 5.5% were alive at 5 years. In patients with stage II disease, high NLR (cut off more than 3) was statistically significantly associated with worse overall survival at 1 year (p=0.02) with only 44% of patients surviving one year or more. Intraoperative blood loss of less than 500mls was found to be associated with better survival at one year (p=0.01) with 80% of patients surviving one year regardless of stage or other factors. Adjuvant chemotherapy was also associated with better survival with 69% of patients being alive at one year (p=0.01) regardless of type of chemotherapy given. The majority of patients received gemcitabine based adjuvant chemotherapy at 44.4% whereas FOLFIRINOX based chemotherapy was given to 31% of patients.

NLR, intraoperative blood loss, and receiving adjuvant chemotherapy were all found to have a statistically significant prognostic association with one year survival within our studied cohort. This is the largest study of resected pancreatic cancers from Saudi Arabia.

The authors.

Has not received any funding.

All authors have declared no conflicts of interest.