Comparing short- and long-term survivors in metastatic pancreatic cancer: Insights into patient and disease profiles impacting systemic therapy outcomes.

[AIM] The study aims to identify prognostic pre-treatment characteristics in patients with metastatic pancreatic adenocarcinoma (mPAC) initiating systemic therapy stratified for short- and long-term survival, to support personalised treatment and improve palliative care outcomes.

[METHODS] This retrospective nationwide study included patients diagnosed with synchronous mPAC and registered in the Netherlands Cancer Registry, 2015-2022, who received palliative systemic therapy. Patient, tumour and treatment characteristics were compared between short-term survivors (STS) (survival <90 days since diagnosis) and long-term survivors (LTS) (survival >365 days since diagnosis). A multivariate analysis was conducted to assess the independent prognostic value of various characteristics on short- and long-term survival outcomes.

[RESULTS] Among 2862 patients with mPAC, 18 % were LTS and 30 % STS. LTS showed better pre-treatment performance status, fewer cardiovascular comorbidities, smaller tumours, lower CA19-9 levels, and more frequently normal albumin and LDH levels. Lung-only metastases occurred more frequently in LTS, while multiple sites predominated in STS. LTS were more often treated with FOLFIRINOX (82 % vs. 61 %). Multivariable analysis showed that older age, poor performance, cardiovascular disease, hypalbuminaemia, elevated LDH and bilirubin levels were prognostic factors indicating worse survival, while diabetes, lower CA19-9 levels, and lung-only metastases favoured longer survival.

[CONCLUSION] Patient- and tumour-specific characteristics strongly influence survival in mPAC patients receiving systemic therapy. These findings can support a more detailed risk stratification at diagnosis to optimise treatment selection, avoid both over- and undertreatment, and align care with individual patient expectations and values for more personalised treatment strategies.