Implications of the Pattern of Disease Recurrence on Survival Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma
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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.
The aim of this study was to characterize the relationship of recurrence patterns with survival in patients with resected PDAC.
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.
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.
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.
The authors would like to thank the Foundation “De Drie Lichten”, Prins Bernhard Cultuurfonds, VSBfonds, Prof. Michaël-van Vloten Fonds, Nijbakker-Morra Foundation, and the Living With Hope Foundation (all from The Netherlands) for funding this study in the form of grants for a research fellowship by VPG.
Vincent P. Groot, Georgios Gemenetzis, Alex B. Blair, Ding Ding, Ammar A. Javed, Richard A. Burkhart, Jun Yu, Inne H. Borel Rinkes, I. Quintus Molenaar, John L. Cameron, Elliot K. Fishman, Ralph H. Hruban, Matthew J. Weiss, Christopher L. Wolfgang, and Jin He have no financial disclosures or conflicts of interest to declare.
- 16.Groot VP, Gemenetzis G, Blair AB, Rivero-Soto RJ, Yu J, Javed AA, et al. Defining and predicting early recurrence in 957 Patients with resected pancreatic ductal adenocarcinoma. Ann Surg. Epub 23 Mar 2018. https://doi.org/10.1097/sla.0000000000002734.