Determining elements linked to post-ascites survival in individuals with metastatic pancreatic cancer (mPC) could inform therapeutic choices and aid in preserving quality of life for this group experiencing significant symptoms. Through retrospective review of medical records, we identified all individuals managed for mPC at the Medical University of Vienna from 2010 to 2019 who experienced ascites during their illness. We examined general risk elements, sites of metastasis, markers of systemic inflammation and hepatic function, along with post-ascites management approaches, for links to survival. The analysis encompassed 117 individuals with mPC and ascites. The median interval from mPC diagnosis to ascites detection was 8.9 months (range 0-99 months), with median overall survival (OS) post-ascites being 27.4 days (range 21.3-42.6 days). Factors at ascites detection independently linked to reduced OS included hepatic metastases [hazard ratio (HR): 2.07, 95% confidence interval (CI) 1.13-3.79, P = 0.018], peritoneal carcinomatosis (HR: 1.74, 95% CI 1.11-2.71, P = 0.015), and portal vein obstruction (HR: 2.52, 95% CI 1.29-4.90, P = 0.007). Relative to best supportive care alone, ongoing systemic treatment following ascites detection was independently linked to survival (HR: 0.35, 95% CI 0.20-0.61, P < 0.001), yielding median OS of 62 days (95% CI 51-129 days, P < 0.001) compared to 16 days (95% CI 11-24 days). Hepatic and peritoneal metastases, together with portal vein obstruction, emerged as predictors of outcome following ascites in mPC cases. Ongoing systemic treatment post-ascites was linked to extended OS, warranting assessment in larger trials incorporating quality-of-life measures.
