Morbidity and Mortality in Patients with Stage IV Pancreatic Adenocarcinoma and Acute Cholangitis: Outcomes and Risk Prognostication

Background Acute cholangitis (AC) is a common complication of pancreatic ductal adenocarcinoma (PDAC). Herein, we evaluated outcomes after the first AC episode and predictors of mortality and AC recurrence in patients with stage IV PDAC. Methods We conducted a single-center, retrospective observational study using institutional databases. Clinical data and outcomes for patients with stage IV PDAC and at least one documented episode of AC, were assessed. Overall survival (OS) was estimated using the Kaplan-Meier method, and Cox regression model was employed to identify predictors of AC recurrence and mortality. Results One hundred and twenty-four patients with stage IV PDAC and AC identified between 01/01/2014 and 10/31/2020 were included. Median OS after first episode of AC was 4.1 months (95% CI, 4.0 - 5.5), and 30-day, 6, and 12-month survival was 86.2% (95% CI, 80.3 – 92.5), 37% (95% CI, 29.3 - 46.6%) and 18.9% (95% CI, 13.1-27.3%), respectively. Primary tumor in pancreatic body/tail (HR 2.29, 95% CI: 1.26 to 4.18, p=0.011), concomitant metastases to liver and other sites (HR 1.96, 95% CI: 1.16 to 3.31, p=0.003) and grade 3 AC (HR 2.26, 95% CI: 1.45 to 3.52, p<0.001), predicted worse outcomes. Intensive care unit admission, sepsis, systemic therapy, treatment regimen, and time to intervention did not predict survival or risk of recurrence of AC. Conclusions AC confers significant morbidity and mortality in advanced PDAC. Worse outcomes are associated with higher grade AC, primary tumor location in pancreatic body/tail, and metastases to liver and other sites.