Evolving survival patterns in pancreatic adenocarcinoma: a 23-year retrospective observational analysis

Pancreatic adenocarcinoma (PA) remains one of the most lethal malignancies. However, treatment options have expanded. Since 2011, FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) and nab-paclitaxel plus gemcitabine have demonstrated superior outcomes over gemcitabine for advanced disease and have become standard chemotherapy regimens. This study aimed to analyze 23-year survival trends in PA at a Brazilian cancer center, focusing on comparisons between the pre- and post-FOLFIRINOX eras.

This retrospective study analyzed patients diagnosed and treated at a large cancer center from 2000 to 2023, examining survival trends and changes in clinicopathological features and treatment across two 12-year periods: Period 1 (2000-2011), before FOLFIRINOX, and Period 2 (2012-2023), after FOLFIRINOX incorporation. The primary objective was to compare overall survival rates between the two time periods. The secondary objective was to evaluate changes in clinicopathological characteristics and treatment modalities.

A total of 1,078 patients were included in this analysis, with 274 patients in Period 1 and 804 patients in Period 2. The proportion of female patients increased in Period 2 (43.8% in Period 1 vs. 50.9% in Period 2, P=0.051), and the median age at diagnosis rose from 62.5 to 66 years (P<0.001). Early-stage tumors (stages I-II) were more frequently diagnosed in Period 2 (16% vs. 29.8%, P<0.001). Chemotherapy use increased from 70.1% (192 patients) in Period 1 to 83.2% (669 patients) in Period 2 (P<0.001), while multimodal therapy (surgery + chemotherapy) rose from 11.3% to 16.7% (P<0.001). Median overall survival (mOS) improved from 7.29 months in Period 1 to 13.24 months in Period 2 (P<0.001), with the 5-year survival increasing from 5.2% to 14.3%. Among the early-stage patients, mOS increased from 19.7 to 34.4 months (P=0.01). No survival difference was observed for stage III disease (mOS: 16.7 vs. 14.8 months, P=0.76), while outcomes for stage IV improved (mOS: 4.76 vs. 9.99 months, P<0.001).

This 23-year analysis highlights the evolving treatment landscape and improved outcomes in PA with the introduction of more effective therapies.