Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands

Abstract

Objective: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival. Summary of Background data: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence. Methods: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014)(2015)(2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence. Results: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001]. Conclusions: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.

Prognosis of Upfront Surgery for Pancreatic Cancer: A Systematic Review and Meta-Analysis of Prospective Studies

“…This might be attributed to the inadequacy of the oncologic preoperative treatment, which was based on chemoradiotherapy (three courses of gemcitabine, associated with radiotherapy 36 Gy). Since most patients undergoing resection will experience distant failure ( 25 , 26 ), it may be hypothesized that a more efficacious multiagent chemotherapy will offer better long-term results than chemoradiotherapy. In this context, PACT-15, a phase 2 randomized study that used multiagent chemotherapy PEXG, showed promising results in patients treated with the perioperative approach (3 months of chemotherapy before and 3 months after surgery).…”

Clinical Impact of Dual Time Point 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Fusion Imaging in Pancreatic Cancer

“…Among 129 events of recurrence or death, 62 (48%) occurred within 1 year of surgery [ 19 ]. Early postoperative recurrence, particularly within 1 year, generally indicates aggressive clinical features and has been associated with worse survival than recurrence after 1 year or longer [ 20 ]. Therefore, recurrence within 1 year of surgery was defined as early recurrence in the present study.…”

Intrafraction pancreatic tumor motion patterns during ungated magnetic resonance guided radiotherapy with an abdominal corset

“…Pancreatic cancer is one of the most aggressive cancer types, with a median overall survival rate of typically around 19 months. For non-metastatic unresectable tumors or isolated local recurrences, prognosis is around 14–15 months [1] , [2] . Stereotactic body radiotherapy (SBRT) has been shown to be a promising therapy for these tumor types in terms of local disease control [3] , [4] , [5] , [6] .…”