Cure Probabilities After Resection of Pancreatic Ductal Adenocarcinoma: A Multi-Institutional Analysis of 2554 Patients

Objective:To assess the probability of being cured of pancreatic ductal adenocarcinoma (PDAC) by pancreatic surgery.Background:Statistical cure implies that a patient treated for a specific disease will have the same life expectancy as if he/she never had that disease.Methods:Patients who underwent pancreatic resection for PDAC between 2010 and 2021 were retrospectively identified using a multi-institutional database. A nonmixture statistical cure model was applied to compare disease-free survival to the survival expected for a matched general population.Results:Among 2554 patients, either in the setting of upfront (n=1691) or neoadjuvant strategy (n=863), the cure model showed that the probability that surgery would offer the same life expectancy (and tumor-free) as the matched general population was 20.4% (95% CI: 18.3, 22.5). Cure likelihood reached the 95% of certainty (time to cure) after 5.3 years (95% CI: 4.7, 6.0). A preoperative model was developed based on tumor stage at diagnosis (P=0.001), radiologic size (P=0.001), response to chemotherapy (P=0.007), American Society of Anesthesiology class (P=0.001), and preoperative Ca19-9 (P=0.001). A postoperative model with the addition of surgery type (P=0.015), pathologic size (P=0.001), tumor grading (P=0.001), resection margin (P=0.001), positive lymph node ratio (P=0.001), and the receipt of adjuvant therapy (P=0.001) was also developed.Conclusions:Patients operated for PDAC can achieve a life expectancy similar to that of the general population, and the likelihood of cure increases with the passage of recurrence-free time. An online calculator was developed and available at https://aicep.website/?cff-form=15.