Hordur Kolbeinsson1, Allison Hoppe2, Aqieda Bayat2, Benjamin Kogelschatz2, Chineze Mbanugo2, Mathew Chung3, Andrea Wolf3, M Mura Assifi3, G Paul Wright3. 1. Spectrum Health General Surgery Residency, Grand Rapids, MI; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI. Electronic address: hordur.kolbeinsson@spectrumhealth.org. 2. Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI. 3. Spectrum Health General Surgery Residency, Grand Rapids, MI; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI.
Abstract
BACKGROUND: Pancreatic ductal adenocarcinoma has a high rate of recurrence after resection. We aimed to investigate patterns of recurrence of pancreatic ductal adenocarcinoma to identify opportunities for targeted intervention toward improving survival. METHODS: This was a retrospective analysis of consecutive patients that underwent curative-intent resection for pancreatic ductal adenocarcinoma between 2007 and 2015. Recurrence and survival were analyzed based on site of recurrence. Multiple clinicopathologic factors were calculated for likelihood of site-specific recurrence. RESULTS: The study included 221 patients with median follow-up of 83 months. Median overall and recurrence-free survival was 19 and 13 months, respectively. Recurrence was observed in 71.9% patients. Local recurrence occurred in 16.4%, distant recurrence in 67.3%, and combined in 15.9%. The most common site of distant recurrence was the liver (49.7%) followed by lung (31.8%) and peritoneum (16.6%). Median time to liver recurrence was shortest (5 months, 95% confidence interval 1.7-8.3) and post recurrence survival was poor (4 months, 95% confidence interval 1.9-6.1). Patients with poorly differentiated tumors on pathology were 4.8 times more likely to recur in the liver (odds ratio 4.83, 95% confidence interval 1.7-13.9). CONCLUSION: Liver metastasis after resection of pancreatic ductal adenocarcinoma occurs most frequently, earliest after surgery, and is rapidly fatal. Liver-directed therapies represent a target for future study.
BACKGROUND: Pancreatic ductal adenocarcinoma has a high rate of recurrence after resection. We aimed to investigate patterns of recurrence of pancreatic ductal adenocarcinoma to identify opportunities for targeted intervention toward improving survival. METHODS: This was a retrospective analysis of consecutive patients that underwent curative-intent resection for pancreatic ductal adenocarcinoma between 2007 and 2015. Recurrence and survival were analyzed based on site of recurrence. Multiple clinicopathologic factors were calculated for likelihood of site-specific recurrence. RESULTS: The study included 221 patients with median follow-up of 83 months. Median overall and recurrence-free survival was 19 and 13 months, respectively. Recurrence was observed in 71.9% patients. Local recurrence occurred in 16.4%, distant recurrence in 67.3%, and combined in 15.9%. The most common site of distant recurrence was the liver (49.7%) followed by lung (31.8%) and peritoneum (16.6%). Median time to liver recurrence was shortest (5 months, 95% confidence interval 1.7-8.3) and post recurrence survival was poor (4 months, 95% confidence interval 1.9-6.1). Patients with poorly differentiated tumors on pathology were 4.8 times more likely to recur in the liver (odds ratio 4.83, 95% confidence interval 1.7-13.9). CONCLUSION: Liver metastasis after resection of pancreatic ductal adenocarcinoma occurs most frequently, earliest after surgery, and is rapidly fatal. Liver-directed therapies represent a target for future study.
Authors: Linda C Chu; Zhen J Wang; Avinash Kambadakone; Elizabeth M Hecht; Jin He; Amol K Narang; Daniel A Laheru; Hina Arif-Tiwari; Priya Bhosale; Candice W Bolan; Olga R Brook; Abraham F Bezuidenhout; Richard K G Do; Samuel J Galgano; Ajit H Goenka; Alexander R Guimaraes; David M Hough; Naveen Kulkarni; Ott Le; Lyndon Luk; Lorenzo Mannelli; Michael Rosenthal; Guillermo Sangster; Zarine K Shah; Erik V Soloff; Parag P Tolat; Marc Zins; Elliot K Fishman; Eric P Tamm; Atif Zaheer Journal: Abdom Radiol (NY) Date: 2022-10-14