Prognostic indicators for intracranial metastases from pancreatic cancer: a population-based retrospective Surveillance, Epidemiology, and End Results database analysis

Abstract

Abstract Purpose The natural history, treatment options, and clinical outcomes of pancreatic metastases to the brain remain largely unknown. Here, we seek to investigate characteristics that influence overall survival (OS) in pancreatic metastases to the brain. Methods This is a population-based retrospective study of OS in 508 patients with pancreatic metastases to the brain using the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression analyses were utilized, and a predictive nomogram was developed. Results All patients had a median OS of 2 months. In the univariate analysis, patients older than 65 years had significantly increased OS (p < 0.001). Patients with liver metastases (p < 0.001) and liver and lung metastases (p < 0.001) exhibited significantly reduced OS. Treatment of the primary tumor with chemotherapy only (p < 0.001), radiation only (p = 0.01), radiation and chemotherapy (p < 0.001), and surgery only (p = 0.01) were associated with increased OS. Resection of a distant metastasis site (p = 0.009) and of a brain metastasis (p = 0.03) were associated with increased OS. In the multivariable analysis, factors that remained significant included patient age (p = 0.01), liver metastases (p < 0.001), liver and lung metastases (p < 0.001), treatment with chemotherapy (p < 0.001), treatment with radiation and chemotherapy (p < 0.001), and treatment with surgery and chemotherapy (p < 0.001). The nomogram had a C-index of 0.766, suggesting congruence between the findings on the nomogram and the results in the internal verification. Conclusions Median OS is influenced by age, multiorgan metastases and treatment of the primary tumor. These data highlight the life-prolonging role of treatment, yet improved quality of life remains to be elucidated.