The role of clinicopathological features in the prognosis of resected pancreatic ductal adenocarcinoma: a retrospective study

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and lethal malignancies, with a poor overall prognosis and low survival rates. Despite advances in treatment, the five-year survival rate remains dismally low, particularly for patients with advanced disease. Several clinicopathological factors have been associated with survival outcomes; however, their prognostic significance remains debated. Objectives: This study aims to investigate the survival rates of patients with resected PDAC and evaluate the association between clinicopathological characteristics and patient survival outcomes. Patients and Methods: The data of patients diagnosed with PDAC who underwent surgical resection at Tehran Cancer Institute between 2013 and 2019 were retrospectively analyzed. Demographic, clinical, and histopathological characteristics were extracted from medical records and pathology reviews. Patients were followed up to assess their 1- and 3-year survival. Survival analysis was conducted using the Kaplan-Meier method, with comparisons made via the Log Rank test. Cox regression was used for multivariate analysis to assess the association between clinicopathological factors and survival. Results: Thirty-seven patients (56.8% female) with PDAC were included in this study, with a mean age of 59.57 ± 9.24 years. The average tumor size was 3.42 ± 1.19 cm, and 67.5% of tumors were located in the pancreatic head. Lymph node involvement was observed in 67.6% of cases, with vascular and perineural invasion present in 91.9% and 94.6% of patients, respectively. The overall median survival was 15.16 months, with 1-year and 3-year survival rates of 56.8% and 27%, respectively. Univariate analysis showed that diabetes was significantly associated with reduced survival, while multivariate analysis indicated that male gender (hazard ratio [HR] =2.44, 95% confidence interval [CI] = 1.04 to 5.74, P=0.04), underlying diseases (HR =3.54, 95% CI = 1.26 to 9.97, P=0.01), and perineural invasion (HR=34.63, 95% CI =1.04 to 1154.8, P=0.04) were linked to a worse prognosis. Conclusion: In our study, we found that underlying diseases, particularly diabetes, male gender, and perineural invasion, were significantly associated with worse survival in PDAC patients. Despite surgical resection, the median survival was 18 months, with only 1/4 of patients alive at three years. These findings highlight the need for further studies to identify prognostic markers and develop more effective treatment strategies.