INCIDENCE TRENDS, SURVIVAL OUTCOMES, AND PREDICTIVE FACTORS FOR ONE-YEAR SURVIVAL IN ADVANCED PANCREATIC DUCTAL ADENOCARCINOMA: A TEN-YEAR SINGLE-CENTER RETROSPECTIVE STUDY

Abstract

Background: Pancreatic cancer remains one of the most lethal malignancies worldwide, with a fiveyear survival rate of less than 10%. Over the past decade, small improvements in survival have resulted from better surgical techniques, new therapies, and advances in systemic treatments. However, the overall prognosis remains poor, as most cases are diagnosed at advanced stages, at which survival rates decline sharply.

Methods: A retrospective review was conducted at the Surin Hospital Cancer Center from January 2015 to January 2025. While overall hospital case trends were evaluated for patients across all stages, the primary survival analysis focused specifically on patients with locally advanced/unresectable and metastatic disease. For this advanced cohort, clinical characteristics and overall survival were evaluated, and independent predictors of one-year survival were identified using multivariable logistic regression.

Results: A total of 212 patients with confirmed pancreatic cancer were included. The cohort was 55.2% male, and 59.9% were over 65 years old. Hospital case volume increased over the ten-year study period. The majority of patients (70.3%) presented with metastatic disease. First-line palliative chemotherapy was administered to 23.4% of patients, while 76.6% received best supportive care (BSC) alone. The overall one-year survival rate was 11.2%. Patients receiving palliative chemotherapy had significantly longer median overall survival (OS) than those receiving BSC alone (7.6 vs. 1.9 months, p < 0.001). Among chemotherapy regimens, FOLFIRINOX yielded a median OS of 17.7 months (95% CI: 10.5–35.8, p = 0.0008) compared to 6.0 months for single-agent gemcitabine. Multivariate logistic regression identified four independent predictors of one-year survival: ECOG performance status 0-1 (aOR = 6.82; 95% CI: 1.32–35.27, p = 0.022), receipt of first-line chemotherapy (aOR = 8.92; 95% CI: 2.78–28.64, p < 0.001), use of FOLFIRINOX (aOR = 12.9; 95% CI: 1.2–137.9, p = 0.034), and serum albumin ≥ 3.5 g/dL (aOR = 3.15; 95% CI: 1.45–6.85, p = 0.004).

Conclusion: The prognosis for locally advanced/unresectable and metastatic pancreatic cancer in this regional cohort remains poor, driven by late-stage diagnoses and a low utilization rate of palliative chemotherapy. However, achieving one-year survival is significantly predicted by favorable baseline health (ECOG performance status 0-1 and serum albumin ≥ 3.5 g/dL) and the receipt of first-line chemotherapy, particularly the FOLFIRINOX regimen. These quantitative findings underscore the critical need to overcome clinical and systemic barriers to administering combination chemotherapy to eligible patients to extend survival.