Chemotherapy for Unresectable Pancreatic Cancer Complicated by Disseminated Intravascular Coagulation: A Retrospective Cohort Study.

OBJECTIVES: This study aimed to characterize the clinical features and prognosis of advanced pancreatic cancer (APC) complicated by disseminated intravascular coagulation (DIC), with a particular focus on distinguishing between tumor-related and infection-related DIC and evaluating the feasibility of chemotherapy in this high-risk population. METHODS: This single-center retrospective study analyzed 284 patients with APC. Clinicopathological features and prognosis were compared between patients with and without DIC. Outcomes were further stratified according to DIC etiology, specifically distinguishing between tumor-related and infection-related DIC. RESULTS: Of 284 patients, 19 (6.7%) developed DIC, including 10 (52.6%) with tumor-related DIC and 9 (47.4%) with infection-related DIC. Overall survival (OS) and time to treatment failure (TTF) differed significantly among the three groups (P<0.001). Patients with tumor-related DIC had the shortest survival, (median OS: 1.3 mo; TTF: 0.85 mo, whereas the non-DIC group showed longest survival (median OS: 10.4 mo; TTF 5.2 mo). In multivariable Cox regression analysis, DIC remained independently associated with poor OS (HR 3.6, 95% CI 2.2-5.8; P<0.001). Among 8 patients with tumor-related DIC who received chemotherapy with concomitant anticoagulant or antifibrinolytic therapy, 4 (50%) achieved resolution of DIC. Notably, DIC recurred upon tumor progression, suggesting that DIC control was temporary and closely tied to tumor response. CONCLUSION: APC with DIC carries a dismal prognosis, particularly when tumor-related. Chemotherapy may be feasible in carefully selected patients with tumor-related DIC when administered with appropriate supportive and anticoagulant or antifibrinolytic therapy; however, its independent contribution to DIC resolution requires cautious interpretation.