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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2018

01-08-2018 | Pancreatic Tumors

Implications of the Pattern of Disease Recurrence on Survival Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma

Authors: Vincent P. Groot, MD, Georgios Gemenetzis, MD, Alex B. Blair, MD, Ding Ding, MD, MS, Ammar A. Javed, MD, Richard A. Burkhart, MD, Jun Yu, MD, PhD, Inne H. Borel Rinkes, MD, PhD, I. Quintus Molenaar, MD, PhD, John L. Cameron, MD, FACS, Elliot K. Fishman, MD, Ralph H. Hruban, MD, Matthew J. Weiss, MD, FACS, Christopher L. Wolfgang, MD, PhD, FACS, Jin He, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 8/2018

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Abstract

Background

After radical resection of pancreatic ductal adenocarcinoma (PDAC), approximately 80% of patients will develop disease recurrence. It remains unclear to what extent the location of recurrence carries prognostic significance. Additionally, stratifying the pattern of recurrence may lead to a deeper understanding of the heterogeneous biological behavior of PDAC.

Objective

The aim of this study was to characterize the relationship of recurrence patterns with survival in patients with resected PDAC.

Methods

This single-center cohort study included patients undergoing pancreatectomy at the Johns Hopkins Hospital between 2000 and 2013. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. Sites of first recurrence were stratified into five groups and survival outcomes were estimated using Kaplan–Meier curves. The association of specific recurrence locations with overall survival (OS) was analyzed using Cox proportional-hazards models with and without landmark analysis.

Results

Accurate follow-up data were available for 877 patients, 662 (75.5%) of whom had documented recurrence at last follow-up. Patients with multiple-site (n = 227, 4.7 months) or liver-only recurrence (n = 166, 7.2 months) had significantly worse median survival after recurrence when compared with lung- (n = 93) or local-only (n = 158) recurrence (15.4 and 9.7 months, respectively). On multivariable analysis, the unique recurrence patterns had variable predictive values for OS. Landmark analyses, with landmarks set at 12, 18, and 24 months, confirmed these findings.

Conclusions

This study demonstrates that specific patterns of PDAC recurrence result in different survival outcomes. Furthermore, distinct first recurrence locations have unique independent predictive values for OS, which could help with prognostic stratification and decisions regarding treatment after the diagnosis of recurrence.
Appendix
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Metadata
Title
Implications of the Pattern of Disease Recurrence on Survival Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma
Authors
Vincent P. Groot, MD
Georgios Gemenetzis, MD
Alex B. Blair, MD
Ding Ding, MD, MS
Ammar A. Javed, MD
Richard A. Burkhart, MD
Jun Yu, MD, PhD
Inne H. Borel Rinkes, MD, PhD
I. Quintus Molenaar, MD, PhD
John L. Cameron, MD, FACS
Elliot K. Fishman, MD
Ralph H. Hruban, MD
Matthew J. Weiss, MD, FACS
Christopher L. Wolfgang, MD, PhD, FACS
Jin He, MD, PhD, FACS
Publication date
01-08-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6558-7

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