BACKGROUND: The incidence of occult metastatic disease (OMD) in pancreatic ductal adenocarcinoma (PDAC) and associated risk factors are largely unknown. METHODS: We identified all patients with PDAC, who had an aborted oncologic operation due to OMD within a 10-year period. The cases were matched to a cohort of resected PDAC patients on a 1:3 ratio, based on age and sex, for comparison of preoperative clinical characteristics and potential risk factors for OMD. RESULTS: In the studied period, 117 patients with OMD were identified in 1423 pancreatectomies performed for PDAC (8%). Liver metastases were the most common finding (79%) followed by peritoneal implants (16%). When compared with non-OMD cases, patients with OMD presented more often with abdominal pain (P < 0.001), and higher preoperative carbohydrate antigen 19-9 (CA 19-9) values ( P = 0.007). Additionally, indeterminate liver lesions on preoperative computed tomography (CT) were identified in 40% of OMD versus 17% of non-OMD patients ( P < 0.001). Multivariable analysis distinguished four independent predictors for OMD: indeterminate lesions on preoperative CT, tumor size > 30 mm, abdominal pain, and preoperative CA 19-9 > 192 U/mL. CONCLUSIONS: Occurrence of OMD in PDAC accounts for 8% of cases. Preoperative CA 19-9 > 192 U/mL, primary tumor size > 30 mm, and identification of indeterminate lesions in preoperative CT may indicate the need for diagnostic laparoscopy.
BACKGROUND: The incidence of occult metastatic disease (OMD) in pancreatic ductal adenocarcinoma (PDAC) and associated risk factors are largely unknown. METHODS: We identified all patients with PDAC, who had an aborted oncologic operation due to OMD within a 10-year period. The cases were matched to a cohort of resected PDACpatients on a 1:3 ratio, based on age and sex, for comparison of preoperative clinical characteristics and potential risk factors for OMD. RESULTS: In the studied period, 117 patients with OMD were identified in 1423 pancreatectomies performed for PDAC (8%). Liver metastases were the most common finding (79%) followed by peritoneal implants (16%). When compared with non-OMD cases, patients with OMD presented more often with abdominal pain (P < 0.001), and higher preoperative carbohydrate antigen 19-9 (CA 19-9) values ( P = 0.007). Additionally, indeterminate liver lesions on preoperative computed tomography (CT) were identified in 40% of OMD versus 17% of non-OMDpatients ( P < 0.001). Multivariable analysis distinguished four independent predictors for OMD: indeterminate lesions on preoperative CT, tumor size > 30 mm, abdominal pain, and preoperative CA 19-9 > 192 U/mL. CONCLUSIONS: Occurrence of OMD in PDAC accounts for 8% of cases. Preoperative CA 19-9 > 192 U/mL, primary tumor size > 30 mm, and identification of indeterminate lesions in preoperative CT may indicate the need for diagnostic laparoscopy.
Authors: Lei Zheng; Ding Ding; Barish H Edil; Carol Judkins; Jennifer N Durham; Dwayne L Thomas; Katherine M Bever; Guanglan Mo; Sara E Solt; Jessica A Hoare; Raka Bhattacharya; Qingfeng Zhu; Arsen Osipov; Beth Onner; Katrina A Purtell; Hongyan Cai; Rose Parkinson; Amy Hacker-Prietz; Joseph M Herman; Dung T Le; Nilofer S Azad; Ana M C De Jesus-Acosta; Alex B Blair; Victoria Kim; Kevin C Soares; Lindsey Manos; John L Cameron; Martin A Makary; Matthew J Weiss; Richard D Schulick; Jin He; Christopher L Wolfgang; Elizabeth D Thompson; Robert A Anders; Elizabeth Sugar; Elizabeth M Jaffee; Daniel A Laheru Journal: Clin Cancer Res Date: 2020-12-04 Impact factor: 13.801
Authors: Kartik S Jhaveri; Ali Babaei Jandaghi; Seng Thipphavong; Osvaldo Espin-Garcia; Anna Dodd; Shawn Hutchinson; Trevor W Reichman; Carol-Anne Moulton; Ian D McGilvary; Steven Gallinger Journal: Cancer Imaging Date: 2021-06-30 Impact factor: 3.909
Authors: Daniel R Principe; Patrick W Underwood; Murray Korc; Jose G Trevino; Hidayatullah G Munshi; Ajay Rana Journal: Front Oncol Date: 2021-07-15 Impact factor: 6.244