Rare long-term survivors of pancreatic adenocarcinoma without curative resection

Table 3 Clinical characteristics of 11 non-resected ≥ 5-year survivors

Patient	Time to initial progression (mo)1	Site of initial progression1	Therapy used for progression	Alive	Overall survival (yr)2	Cause of death	Clinical progress
1	15.3	Supraclavicular lymph node	5-FU + R	Yes	8.6	N/A	Recurrence in the supraclavicular lymph node was treated with 5-FU and radiotherapy. No further therapy was required and the patient remains alive 8.6 yr after diagnosis
2	37.1	Peritoneum	GD	Yes	5.9	N/A	Prophylactic double bypass surgery was performed at diagnosis. Initial chemotherapy was interrupted by ischemic bowel but completed subsequently. Peritoneal recurrence was treated with GD intermittently over 2.5 yr. The patient remains alive 5.9 yr after diagnosis
3	N/A	N/A	N/A	Yes	5.7	N/A	Resection was attempted however aborted due to occluded common hepatic artery. No major medical issues following initial chemoradiation was noted and the patient remains alive 5.7 yr after diagnosis
4	N/A	N/A	N/A	Yes	5.6	N/A	After initial therapy, patient developed gastric outlet and biliary obstruction requiring endoscopic and radiology interventions. Patient then received salvage therapy for 4 mo with gemcitabine-based combination therapy. This was later stopped as imaging demonstrated stable disease. The patient remains alive 5.6 yr after diagnosis
5	N/A	N/A	N/A	Yes	5.5	N/A	Patient has a remarkable family history of cancers in multiple family members and BRCA2 gene mutation. Initial therapy was stopped prematurely due to financial issue. GD was re-commended as maintenance therapy for 5 mo. No further therapy was required afterwards and the patient remains alive 5.5 yr after diagnosis
6	N/A	N/A	N/A	No	8.4	Perforated duodenal ulcer and sepsis	Patient's progress was hampered by recurrent cholangitis requiring multiple biliary interventions and second malignancies (breast cancer at 5 yr after the initial diagnosis of pancreatic cancer, recurrent hypernephroma metastasizing to the bone at 7 yr after the initial diagnosis)
7	87.3	Local, mesenteric lymph node, peritoneum	Palliation	No	7.5	Biliary sepsis	After initial therapy, patient developed gastric outlet and biliary obstruction treated with endoscopic stent placement and double bypass surgery. The patient suffered from chronic pain and malnutrition necessitating supplemental feeding and narcotics via intrathecal pump, respectively. Seven years after the diagnosis, the patient developed bowel perforation at the site of previously placed duodenal stent and died from sepsis
8	N/A	N/A	N/A	No	6.4	Biliary sepsis	The tumor was resectable but cirrhosis discovered incidentally at laparoscopy precluded patient from resection. The patient developed bladder cancer (2 yr after diagnosis) treated with resection and chemotherapy, and chronic renal failure due to glomerulonephritis (6 yr after diagnosis) requiring hemodialysis. The patient underwent multiple interventions for recurrent cholangitis
9	37.1	local, liver	GD	No	6.4	Disease progression	ERCP at the time of diagnosis was complicated by perforated duodenal diverticulum requiring surgery for the repair of perforation and double bypass surgery at the same time. GD was used intermittently to treat disease progression over 5 yr until death
10	33.6	local	GD	No	6.2	Sepsis due to ascitic fluid infection/peritonitis	Prophylactic double bypass surgery was performed at diagnosis. Patient was later treated with GD and investigational monoclonal antibody therapy for local and peritoneal recurrence, respectively
11	27.8	Lung	GD	No	5.2	Disease progression	Patient experienced recurrent cholangitis and liver abscess requiring multiple biliary interventions

¹Disease progression was defined as the presence of recurrent tumor in the pancreas (local) or development of new metastatic focus in a distant organ (systemic) coinciding with patient’s symptom and/or rise in Ca 19-9. Time to initial progression was measured from initial diagnosis (the date with the first pathological evidence of pancreatic adenocarcinoma) to the date of first progression;

²Overall survival was calculated from initial diagnosis to the date of death. The actual date of death was confirmed in all patients by assessing the cancer registry. N/A: Not applicable; GD: Gemcitabine and doxetaxel; 5-FU + R: 5-fluorouracil and radiotherapy.