Survival Impact of Pulmonary Metastasis as Recurrence of Pancreatic Ductal Adenocarcinoma

Abstract

Aim: This study aimed at investigating the survival impact of pancreatic ductal adenocarcinoma (PDAC) recurrence as pulmonary metastasis. Methods: We performed a retrospective case-control study of 142 patients who underwent curative resection for PDAC at our institution between 2003 and 2012. Clinicopathological features were compared among patients stratified according to the recurrence pattern and pulmonary metastasis treatment strategy. Results: Patients underwent pancreaticoduodenectomy (n = 96), distal (n = 42), or total pancreatectomy (n = 4). At the last follow-up, 99 patients had developed recurrent post-resection PDAC, including 14 cases of isolated pulmonary recurrence. The median overall survival was significantly longer for patients with isolated pulmonary recurrence (40.3 months) than with other metastases (20.9 months; HR 5.85; p = 0.0156). Two patients underwent resection for isolated pulmonary recurrence, and both survived for ∼70 months after primary resection. Conclusion: Patients with first recurrence of PDAC as pulmonary metastasis had a better prognosis than patients with other types of metastases. Moreover, when isolated pulmonary metastasis is controlled for a certain period, pulmonary resection is likely to improve patient survival.

Meta-analysis of recurrence pattern after resection for pancreatic cancer

“…The weighted median OS in 13 studies was 19·8 (range 14·0–30·0) months for LR recurrence, 15·0 (10·0–17·7) months for liver recurrence, 30·4 (24·1–40·3) months for lung recurrence and 14·1 (5·5–17·0) months for PeD ( Fig . ).…”

“…After removal of 690 duplicates, a further 2588 articles were excluded after title and abstract screening because they did not meet the prespecified inclusion criteria. The full texts of the remaining 468 studies were evaluated in more detail, and 89 studies were found to meet the eligibility criteria for this systematic review. Among them, 22 studies containing information on clinical factors relevant to recurrence sites were selected for the meta‐analysis.…”

“…The Cochrane Collaboration tool for assessing risk of bias showed that one study had no domain with a high risk of bias and three studies had one of seven domains with a high risk of bias ( Table S3 , supporting information). The overall risk of bias in non‐randomized studies, according to ROBINS‐I, was moderate in 48 studies and serious in 37 studies ( Table S4 , supporting information).…”

“…). Data on RFS were available from 17 studies, and survival after recurrence was reported in nine studies. The weighted median RFS and survival after recurrence were 12·7 (8·0–20·0) and 7·9 (5·0–13·9) months respectively for LR recurrence, 7·7 (5·0–12·0) and 6·5 (range 5·0–8·8) months for liver recurrence, 15·6 (5·2–19·6) and 12·1 (8·8–20·0) months for lung recurrence, and 8·8 (2·0–15·0) and 4·3 (1·7–7·0) months for PeD.…”

Transient and Local Expression of Chemokine and Immune Checkpoint Traps To Treat Pancreatic Cancer

“…Consistent with the patients bearing PDAC, liver and lung are the major metastatic sites for orthotopic KPC models (Figure 4A,B). 40,41 Tumors were also observed in spleen and kidney due to invasion of the peritoneal cavity. 42 Histology shows large nodules of metastasis in the lung, spleen, and liver of the control group (Figure 4C).…”