Wangjam Tamna, Zhang Zhe, Zhou Xian Chong, Lyer Laxmi, Faisal Farzana, Soares Kevin C, Fishman Elliott, Hruban Ralph H, Herman Joseph M, Laheru Daniel, Weiss Matthew, Li Min, De Jesus-Acosta Ana, Wolfgang Christopher L, Zheng Lei
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Hematology and Oncology, University of Texas Health Science Center, San Antonio, TX, USA.
Oncotarget. 2015 Nov 3;6(34):36903-10. doi: 10.18632/oncotarget.5054.
The majority of patients with curative resection of pancreatic ductal adenocarcinoma recur within 5 years of resection. However, the prognosis associated with different patterns of recurrence has not been well studied. A retrospective review of patients who underwent curative surgical resection of pancreatic cancer was performed. Of the 209 patients, 174 patients developed recurrent disease. Of these 174, 28(16.1%) had recurrent disease limited to lung metastases, 20(11.5%) had recurrence in the lung plus one or more other sites excluding the liver, 73(42.0%) had liver metastasis alone or liver metastasis with any other site except lung, 28(16.1%) local recurrence only, and 25(14.3%) peritoneal recurrence alone or together with local recurrence. Patients with recurrence limited to lung had a 8.5 months(Mo) median survival from recurrence to death, which was significantly better than the survival associated with recurrence in the liver(5.1Mo), in the peritoneum(2.3Mo) or locally(5.1Mo) in multivariable analyses. Among all groups, the time from surgery to the diagnosis of recurrence in patients who recurred in only in the lung was also the longest. However, 75% of patients were found to have indeterminate lung nodules on their surveillance CT scans prior to the diagnosis of recurrence in lung. This delayed diagnosis of lung recurrence may have a negative impact on survival after recurrence. In conclusion, pancreatic cancer with lung recurrence has a significantly better prognosis than recurrence in other sites. Further studies are needed to investigate how different diagnostic and treatment modalities affect the survival of this unique subpopulation of pancreatic cancer patients.
大多数接受胰管腺癌根治性切除的患者在切除后5年内复发。然而，与不同复发模式相关的预后尚未得到充分研究。对接受胰腺癌根治性手术切除的患者进行了回顾性分析。在209例患者中，174例出现复发疾病。在这174例患者中，28例（16.1%）复发疾病仅限于肺转移，20例（11.5%）肺部复发并伴有一个或多个除肝脏外的其他部位复发，73例（42.0%）仅发生肝转移或肝转移合并除肺外的任何其他部位转移，28例（16.1%）仅局部复发，25例（14.3%）仅腹膜复发或腹膜复发合并局部复发。复发仅限于肺部的患者从复发到死亡的中位生存期为8.5个月（Mo），在多变量分析中，这显著优于肝脏复发（5.1Mo）、腹膜复发（2.3Mo）或局部复发（5.1Mo）患者的生存期。在所有组中，仅肺部复发的患者从手术到复发诊断的时间也是最长的。然而，75%的患者在肺部复发诊断前的监测CT扫描中发现有不确定的肺结节。这种肺部复发的延迟诊断可能会对复发后的生存产生负面影响。总之，胰腺癌肺部复发的预后明显优于其他部位的复发。需要进一步研究来调查不同的诊断和治疗方式如何影响这一独特亚组胰腺癌患者的生存。
