E. Hammelef1, R. Huang1, M. Sabitsky1, C. Ream1, S. Khalilieh2, N. Zohar2, H. Lavu2, W. Bowne2, C. Yeo2, A. Nevler2 1Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA 2Thomas Jefferson University, Jefferson Pancreas, Biliary And Related Cancer Center, Department Of Surgery, Philadelphia, PA, USA
Introduction:
Pancreatic ductal adenocarcinoma (PDAC) is the 3rd leading cause of cancer deaths in the United States, with an overall 5-year survival of only 11%. Hypoxic and hypercapnic tumor microenvironments have been suggested to promote tumor proliferation and resistance to chemotherapy. In our study, we aimed to validate chronic obstructive pulmonary disease (COPD) as a prognostic factor in PDAC and other pancreaticobiliary cancers.
Methods:
In this retrospective review of a prospectively maintained institutional database, 1099 patients who underwent a pancreaticoduodenectomy between 2015-2021 were assessed. Charts were reviewed for evidence of chronic respiratory disorders, including COPD, asthma, sleep apnea, or persistent inhaler use. For all patients, demographic, perioperative, histologic, and oncologic outcome data were collected and analyzed. Kaplan-Meier and Cox regression analyses were utilized to assess survival.
Results:
We identified 510 PDAC and periampullary adenocarcinoma patients, 255 males and 255 females, with a median age of 68 years (29-95 years) and a median pre-operative BMI of 25.6 kg/m2 (15.4-49 kg/m2). Thirty percent of our patients (N=153) had no history of smoking. Over half of the patients reported a history of smoking (N=266, 52.2%). Of these past smokers, the majority had stopped smoking prior to surgery (85%, N=226). Approximately 18% of patients (N=91) had inconclusive smoking data. A total of 42 patients (8.2%) had COPD. The average resected tumor size was 2.9±1.4 cm and 66.9% of the patients (N=341) were positive for specimen lymph node involvement. Postoperatively, the cohort’s median survival was 29.6±1.9 months. Kaplan-Meier analysis showed that COPD was associated with worse overall survival (23.3±5.3 months vs. 30.6±2.2 months, p=0.019). Cox regression analysis showed COPD to be an independent prognostic factor (HR=1.6, 95%CI 1.0-2.4), p=0.041) along with tumor size, margin status, lymphovascular invasion, perineural invasion, and chemotherapy treatment (Figure 1; p<0.05, each). Survival analysis in a subset of patients with asthma (N=48) revealed a lesser trend toward poorer prognosis (25.9±5.7 months vs. 30.4±2.1 months, p=0.11), which was not found to be independent in a Cox regression model. Smoking history, regardless of current smoker or former smoker status, was not found to be a prognostic marker for survival.
Conclusion:
Pancreatic cancer is a prevalent disease with a poor prognosis. Our study shows that COPD is strongly associated with markedly worse survival in patients with PDAC. Therefore, COPD status should be considered in the clinical setting in physician-patient discussions and clinical decision-making, and perhaps also in plans for post-resection treatment.
