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

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.

Isolated pulmonary recurrence after resection of pancreatic cancer: the effect of patient factors and treatment modalities on survival

“…22 Similarly, multiple studies have shown that lung-only recurrence after PDAC resection results in superior survival when compared to other recurrence patterns, such as liver-only, peritoneal or multiple-site recurrence. [10][11][12]20 The OS for patients with pulmonary recurrence in these studies (median 36 12 , 36 20 , and 40 11 months) was remarkably similar to the 40 months found in the current study, further supporting the hypothesis that favorable tumor biology exists in these patients.…”

“…5 However, recent evidence suggests that recurrent PDAC displays diverse behaviors based on recurrence timing and location. [6][7][8][9][10] These differences potentially provide a basis for a more individualized approach to the treatment of recurrence. Isolated pulmonary recurrence in particular has been associated with prolonged survival when compared to recurrence at other sites.…”

Meta-analysis of recurrence pattern after resection for pancreatic cancer

“…Several studies have linked specific recurrence locations to different predictive factors, including R1 resection margin and low‐grade tumour differentiation. In addition, various sites of initial recurrence may be associated with different survival rates. For example, lung relapse as the first location occurs later than recurrence in the liver or at other sites.…”

Patterns of Local-regional Failures after Adjuvant Chemotherapy in Resected Pancreatic Cancer without adjuvant radiation therapy: Implication for Irradiation Volumes Design

“…Since not all PDAC patients recur in the same manner, understanding the pattern, timing, and implications of recurrence is critical to the planning of adjuvant strategies. In addition, clinicopathologic risk factors for predicting failure patterns could potentially allow individualized and more effective adjuvant therapy strategies [17,18]. However, to our best knowledge, there is no published studies to specially investigate the risk predictor factors for isolated LRR in PDCA patients by using competing risk regression model, and the patterns of local regional recurrence of lymph node are remains undetermined.…”