Long Term Survivor of Stage IV Pancreatic Adenocarcinoma: A Case Report

Abstract

Introduction: Pancreatic cancer presents a significant public health challenge in Korea, with an increasing incidence rate in recent years. The prognosis of pancreatic cancer in Korea is poor, marked by a 5-year survival rate of only 9.5%. Stage IV pancreatic cancer, in particular, carries an exceptionally poor prognosis, with a median survival period of 3 to 6 months. Here, we present a case of a patient with stage IV pancreatic adenocarcinoma with an unusual survival time of 34 months after initial diagnosis. Case presentation: Our patient, an 80-year-old Korean woman, received her initial pancreatic cancer diagnosis in August 2019. The initial CT scan revealed that the cancer had invaded the head of the pancreas as well as the superior mesenteric vein, splenic vein, and main portal vein. Additionally, there was a strong suspicion of seeding metastasis, leading to the exclusion of surgery. The medical team administered approximately 20 cycles of gemcitabine/nab-paclitaxel combination as palliative chemotherapy, according to the Korean Pancreatic Cancer treatment recommendations. Following subsequent palliative chemotherapy, the patient’s CA19-9 levels immediately decreased and remained stable, with occasional fluctuations occurring after the interruption of chemotherapy. The patient declined further chemotherapy after the completion of the 20th cycle in November 2021. Alongside the cancer diagnosis, the patient was also diagnosed with chronic cholangitis with common bile duct stones, liver abscess, and acute enter colitis. In June 2022, the patient was admitted for a final visit due to abdominal pain caused by acute gastroenteritis. With a deteriorating condition, the patient requested a transfer to a local hospital for hospice care and died approximately 34 months after the initial diagnosis. Conclusion: The patient’s initial sensitivity and lack of resistance to chemotherapy as well as good nutrition and physical health seemed to be the main contributors to the patient’s exceptional survival.