Clinical Implications of NRAS Overexpression in Resectable Pancreatic Adenocarcinoma Patients
BACKGROUND Pancreatic cancer represents a fatal malignancy leading to premature death and loss of life expectancy. The aim of the present study was to assess how many years of life are lost due to this cancer, in relationship with surgery and ageing. METHODS Data from 716 consecutive patients discharged from a tertiary referral hospital (2002-2012) with a diagnosis of pancreatic cancer and with complete clinical and follow-up data were used to estimate the number of years of life-lost (YLL) through a semi-parametric extrapolation having an age-, sex- and year-of-onset- matched population derived from national life tables as reference. RESULTS The mean entire lifespan estimated for the 716 patients was 1.4 years (95% C.I.:0.8-1.9) resulting in a number of YLL after diagnosis of 12 years (95% C.I.:11.5-12.6) per person. Surgical patients (147 cases; 20.5%) were younger and experienced higher post-diagnostic lifespan (3.5 years) than non-surgical older individuals (0.8 years; p < 0.001). These figures were reflected on the number of expected YLL (EYLL) that remained substantially unaffected by surgery (p = 0.821). Patients aged ≤68 years experienced the highest number of EYLL (20.8 years); whereas elderly patients had a loss of life that corresponded to only 6% of the entire life they had already lived. CONCLUSIONS In a typical pancreatic cancer cohort, surgery was not able to modify population-based statistics because of a different age at tumor onset which nullifies any benefit from a "lifespan from birth" perspective. Pancreatic cancer in younger individuals must be ranked within the very first causes of EYLL due to malignancy.