Patient prognostication and long-term survival in resected pancreatic ductal adenocarcinoma

The field of pancreatic cancer has undergone multiple evolutions and revolutions. The current landscape involves increased utilization of multiagent chemotherapies in the neoadjuvant setting, higher rate of resections of borderline and locally advanced disease, and more patients achieving long-term survival. Prognostication is critical to patient management and understanding long-term survival can provide important clinical insights. Historically, multiple prognostic factors have been identified in resected pancreatic cancer. However, neoadjuvant therapy could impact their prognostic relevance. It is critical to update current prognostic tools, so they remain applicable to current practice.
Part II of this thesis demonstrates that the prognostic implication of historically established factors is altered after neoadjuvant therapy. Novel prognostic models that are applicable to both chemo-naïve and neoadjuvant therapy patients were developed for clinical use. In Part III, examination of long-term survivors demonstrated that historically established factors have a time-varying effect on survival, their presence does not preclude long-term survival, and currently our prediction remains modest. In Part IV it is demonstrated that biomarkers including circulating tumor cells and circulating tumor DNA show promise in improving prognostication and prediction of long-term survival. Lastly, Part V details the establishment of the PANC-PALS Consortium which is aimed at developing a global network of experts in the field to allow for large scale collaborative research efforts. In the cycle of evolutions and revolutions in the field hopefully work in this thesis will facilitate the next revolution that ushers in the era of biomarker-based precision medicine and improved patient outcomes in pancreatic cancer.