The Significance of Ascites in Patients with Pancreatic Ductal Adenocarcinoma: A Case-Control Study

Marina Baretti, Bhargavi Pulluri, Hua Ling Tsai, Amanda L. Blackford, Christopher Wolfgang, Daniel Laheru, Lei Zheng, Joseph Herman, Dung Le, Amol Narang, Ana De Jesus-Acosta

Research output: Contribution to journalArticle

Abstract

Objective Limited data exist on the impact of ascites in pancreatic ductal adenocarcinoma (PDAC). We evaluated the survival outcomes of patients with PDAC and ascites. Methods Retrospective, single-institution, case-control study including patients with newly diagnosed PDAC from 2007 to 2016. One hundred fifty-four patients with ascites at diagnosis (case group) and 154 controls were matched on age, sex, stage, Eastern Cooperative Oncology Group performance, surgical treatment, lymph node, and margin status. Ascites was defined as computed tomography-detected fluid in the pelvic/peritoneal cavity. Overall survival was compared between groups via Cox proportional hazards models with a gamma frailty term to account for the correlation between matched pairs on entire cohort and by disease stages for subgroup analysis. Results The 154 matched cases included 24 resectable, 19 borderline resectable, 51 locally advanced, and 60 metastatic disease. Patients with ascites had higher risk of death compared with those without (conditional hazard ratio, 1.58; 95% confidence interval, 1.23-2.03; P < 0.001). Stratified analysis showed a significant association between ascites and poor prognosis in patients with localized disease (conditional hazard ratio, 1.62; 95% confidence interval, 1.18-2.24; P = 0.003). Conclusions Radiographic ascites is a poor prognostic factor in PDAC. Our findings may aid physicians in considering systemic therapy prior to attempting local treatments.

Original languageEnglish (US)
Pages (from-to)585-589
Number of pages5
JournalPancreas
Volume48
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Ascites
Case-Control Studies
Adenocarcinoma
Confidence Intervals
Survival
Peritoneal Cavity
Proportional Hazards Models
Therapeutics
Lymph Nodes
Tomography
Physicians
Control Groups

Keywords

  • Abbreviations
  • ascites
  • localized disease
  • metastatic disease
  • overall survival
  • pancreas adenocarcinoma
  • peritoneal carcinomatosis

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

The Significance of Ascites in Patients with Pancreatic Ductal Adenocarcinoma : A Case-Control Study. / Baretti, Marina; Pulluri, Bhargavi; Tsai, Hua Ling; Blackford, Amanda L.; Wolfgang, Christopher; Laheru, Daniel; Zheng, Lei; Herman, Joseph; Le, Dung; Narang, Amol; De Jesus-Acosta, Ana.

In: Pancreas, Vol. 48, No. 4, 01.04.2019, p. 585-589.

Research output: Contribution to journalArticle

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AU - Blackford, Amanda L.

AU - Wolfgang, Christopher

AU - Laheru, Daniel

AU - Zheng, Lei

AU - Herman, Joseph

AU - Le, Dung

AU - Narang, Amol

AU - De Jesus-Acosta, Ana

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N2 - Objective Limited data exist on the impact of ascites in pancreatic ductal adenocarcinoma (PDAC). We evaluated the survival outcomes of patients with PDAC and ascites. Methods Retrospective, single-institution, case-control study including patients with newly diagnosed PDAC from 2007 to 2016. One hundred fifty-four patients with ascites at diagnosis (case group) and 154 controls were matched on age, sex, stage, Eastern Cooperative Oncology Group performance, surgical treatment, lymph node, and margin status. Ascites was defined as computed tomography-detected fluid in the pelvic/peritoneal cavity. Overall survival was compared between groups via Cox proportional hazards models with a gamma frailty term to account for the correlation between matched pairs on entire cohort and by disease stages for subgroup analysis. Results The 154 matched cases included 24 resectable, 19 borderline resectable, 51 locally advanced, and 60 metastatic disease. Patients with ascites had higher risk of death compared with those without (conditional hazard ratio, 1.58; 95% confidence interval, 1.23-2.03; P < 0.001). Stratified analysis showed a significant association between ascites and poor prognosis in patients with localized disease (conditional hazard ratio, 1.62; 95% confidence interval, 1.18-2.24; P = 0.003). Conclusions Radiographic ascites is a poor prognostic factor in PDAC. Our findings may aid physicians in considering systemic therapy prior to attempting local treatments.

AB - Objective Limited data exist on the impact of ascites in pancreatic ductal adenocarcinoma (PDAC). We evaluated the survival outcomes of patients with PDAC and ascites. Methods Retrospective, single-institution, case-control study including patients with newly diagnosed PDAC from 2007 to 2016. One hundred fifty-four patients with ascites at diagnosis (case group) and 154 controls were matched on age, sex, stage, Eastern Cooperative Oncology Group performance, surgical treatment, lymph node, and margin status. Ascites was defined as computed tomography-detected fluid in the pelvic/peritoneal cavity. Overall survival was compared between groups via Cox proportional hazards models with a gamma frailty term to account for the correlation between matched pairs on entire cohort and by disease stages for subgroup analysis. Results The 154 matched cases included 24 resectable, 19 borderline resectable, 51 locally advanced, and 60 metastatic disease. Patients with ascites had higher risk of death compared with those without (conditional hazard ratio, 1.58; 95% confidence interval, 1.23-2.03; P < 0.001). Stratified analysis showed a significant association between ascites and poor prognosis in patients with localized disease (conditional hazard ratio, 1.62; 95% confidence interval, 1.18-2.24; P = 0.003). Conclusions Radiographic ascites is a poor prognostic factor in PDAC. Our findings may aid physicians in considering systemic therapy prior to attempting local treatments.

KW - Abbreviations

KW - ascites

KW - localized disease

KW - metastatic disease

KW - overall survival

KW - pancreas adenocarcinoma

KW - peritoneal carcinomatosis

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