Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer

Abstract

Background: Pancreatic cancer is a catastrophic disease with high recurrence and death rates, even in early stages. Early detection and early treatment improve survival in many cancer types but have not yet been clearly documented to do so in pancreatic cancer. In this study, we assessed the benefit on survival resulting from different patterns of surveillance in daily practice after curative surgery of early pancreatic cancer. Methods: Patients with pancreatic ductal adenocarcinoma who had received curative surgery between January 2000 and December 2013 at our institute were retrospectively reviewed. Patients were classified into one of four groups, based on surveillance strategy: the symptom group, the imaging group, the marker group (carbohydrate antigen 19-9 and/or carcinoembryonic antigen), and the intense group (both imaging and tumor marker assessment). Overall survival (OS), relapse-free survival (RFS), and post-recurrence overall survival (PROS) were evaluated. Results: One hundred and eighty-one patients with documented recurrence or metastasis were included in our analysis. The median OS for patients in the symptom group, imaging group, marker group, and intense group were 21.4 months, 13.9 months, 20.5 months, and 16.5 months, respectively (p = 0.670). Surveillance with imaging, tumor markers, or both was not an independent risk factor for OS in univariate and multivariate analyses. There was no significant difference in median RFS (symptom group, 11.7 months; imaging group, 6.3 months; marker group, 9.3 months; intense group, 6.9 months; p = 0.259) or median PROS (symptom group, 6.9 months; imaging group, 7.5 months; marker group, 5.0 months; intense group, 7.8 months; p = 0.953) between the four groups. Multivariate analyses identified poor Eastern Cooperative Oncology Group Performance Status (ECOG PS) (≥1), primary tumor site (tail), and tumor grade (poor differentiation) were poor prognostic factors for OS. Conclusions: Surveillance with regular imaging, tumor marker, or both was not an independent risk factor for OS of pancreatic cancer patients who undergo curative tumor resection.

Tumor conspicuity significantly correlates with postoperative recurrence in patients with pancreatic cancer: a retrospective observational study

“…Tumor grade can also be a significant prognostic factor for survival [6,17,18]; however, in this study, tumor grade had no impact on prognosis. This might be because the majority of the study population had well or moderately differentiated cancers (n = 51), rendering little variability within the three grades of tumor.…”

Impact of surveillance among patients with resected pancreatic cancer following adjuvant chemotherapy

“…A retrospective review of patients with resected ductal adenocarcinoma between 2000 and 2013 was done by Wu et al, investigating differences in median overall survival between four different surveillance strategy groups: symptom group, imaging group, tumor marker group, and intense group (history/ physical, tumor markers, and imaging). They did not find any statistical difference between the four subgroups, albeit the authors also acknowledged that more recent advances in palliative chemotherapy, such as FOLFIRINOX, and advances in treatments for local recurrences may not have been encompassed by their patient sample (27). Similarly, Witkowski et al quantified nationwide use of imaging after pancreatic cancer resection and found a doubling in the median number of scans done between 1991 and 2005, but no associated survival benefit (28).…”

“…The development of a surveillance schedule requires multiple considerations including cost-effectiveness (38), modality of surveillance, frequency, and duration. CA19-9 has been previously demonstrated to be predictive of survival (27,(39)(40)(41), and the observation of its rise preceding detection of recurrence by imaging (42) may be helpful as a more cost-effective surveillance modality than imaging alone. Similar to previous studies which have found the highest risk of recurrence 2 years after surgery (43,44), 78% of recurrences occurred within 2 years in our study.…”

Predictive value of CONUT score combined with serum CA199 levels in postoperative survival of patients with pancreatic ductal adenocarcinoma: a retrospective study

“…Numerous studies have shown that tumor size, lymph node metastasis, vascular invasion and serum tumor markers (TMs) are vital prognostic factors for PC (Karamitopoulou et al, 2013;Staal et al, 2019;Winter, Yeo & Brody, 2013). Moreover, early detection of postoperative recurrence can help improve the survival rate of patients with PDAC (Wu et al, 2019); therefore, it is important to determine the factors affecting the prognosis of these patients after pancreatectomy. It is not difficult to obtain the serum TMs level of patients from clinical data, which is of potential value for diagnosis, monitoring of postoperative recurrence and predicting survival rate (Fujioka et al, 2007).…”