Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis

Abstract

BACKGROUNDIn pancreatic cancer, acute pancreatitis (AP) is a serious morbidity, but its negative effect on long-term outcomes remains to be elucidated.AIMTo investigate the effects of AP on the tumor recurrence pattern of pancreatic ductal adenocarcinoma (PDAC) and tumor-specific survival.METHODSThe medical records of 219 patients with curative pancreatectomy for pancreatic cancer at the Pancreatic Surgery Center of West China Hospital from July 2012 to December 2016 were analyzed retrospectively. The severity of acute pancreatitis was classified according to the Atlanta classification of AP. The patient demographics and tumor characteristics were assessed. Early recurrence was defined as a relapse within 12 mo after surgery. Overall and disease-free survival and recurrence patterns were analyzed. Mild acute pancreatitis was excluded because its negative effects can be negligible.RESULTSEarly recurrence in AP group was significantly higher than in non-AP group (71.4% vs 41.2%; P = 0.009). Multivariate analysis of postoperative early recurrence showed that moderate or severe AP was an independent risk factor for an early recurrence [odds ratio (OR): 4.13; 95% confidence interval (CI): 1.41-12.10; P = 0.01]. The median time to recurrence was shorter in patients with AP than in those without (8.4 vs 12.8 mo; P = 0.003). Multivariate analysis identified AP as an independent prognostic factor for overall survival [relative risk (RR): 2.35; 95%CI: 1.45-3.83] and disease-free survival (RR: 2.24; 95%CI: 1.31-3.85) in patients with PDAC.CONCLUSIONPatients with moderate or severe acute pancreatitis developed recurrences earlier than those without. Moderate or severe AP is associated with shorter overall and disease-free survival of patients with PDAC.

Post-pancreatitis diabetes mellitus and excess intra-pancreatic fat deposition as harbingers of pancreatic cancer

“…IPFD was also investigated in the setting of pancreatitis—a major risk factor for pancreatic cancer[ 13 , 24 - 27 ]. A cross-sectional study by Stuart et al [ 28 ] investigated 119 individuals after an attack of pancreatitis and 38 healthy volunteers.…”

Long-term outcome after EUS-guided radiofrequency ablation: Prospective results in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms

“…The late response was a case considered as a failure at 1 year despite negative CEH EUS; the tumor disappeared completely at 53-month follow-up. We postulate that it could be a delayed success related to the activated immune response associated with RFA [18][19][20][21][22][23][24][25][26]. Conversely, an 18-mm NET located in the body of the pancreas seemed to disappear at 1 year after the size decreased to 13 mm at 6 months.…”

“…Although these results regarding short-term efficacy are interesting, surgery remains the treatment of choice in the absence of longterm follow-up and randomized series. However, regarding the results of surgical resection of benign tumors like NETs, the mortality rates range from 3 % to 14 % and morbidity rates from 15 % to 30 % compared to no mortality and morbidity ranging from 3 % to 10 % with EUS-RFA [21,22].…”

Meta-analysis reveals an association between acute pancreatitis and the risk of pancreatic cancer

“…A recent study performed by Gong et al[ 30 ], suggesting that a shorter overall survival for pancreatic ductal adenocarcinoma who got a AP than those without a history of AP and the HR for mortality was 1.808 (95%CI: 1.241-2.632). Similarly, it has been reported that AP is an independent risk factor for recurrence of PC (OR = 4.13; 95%CI: 1.41-12.10) and AP is associated with a worse disease-free survival of patients with PC[ 31 ]. Therefore, even if AP did not show a stronger association of PC risk compared with chronic pancreatitis, the relationship between AP and PC risk should be taken seriously.…”