Stahl John M, Walther Zenta, Chang Bryan W, Hochster Howard S, Johung Kimberly L
Department of Therapeutic Radiology, Yale University School of Medicine.
Department of Pathology, Yale University School of Medicine.
Cureus. 2017 Feb 2;9(2):e1007. doi: 10.7759/cureus.1007.
Aggressive local therapy for patients with oligometastatic pancreatic ductal adenocarcinoma (PDAC) has traditionally not been pursued due to high rates of distant progression. We describe a 62-year-old male initially presenting with resectable PDAC who underwent the Whipple procedure but developed multiple liver metastases within two months of starting adjuvant gemcitabine. Oxaliplatin was added to the regimen and complete resolution of the liver lesions resulted. He remained disease-free for five years until re-staging revealed a small lung nodule. This was resected and confirmed to be metastatic PDAC. After additional adjuvant gemcitabine, the patient remained free of recurrence for 12 years after diagnosis of metastatic disease and ultimately passed away from complications of ascending cholangitis associated with stricture at the biliary-enteric anastomosis site. He had no evidence of disease recurrence at the time of death. Next-generation sequencing of the tumor was unrevealing, showing only an activating mutation of KRAS and a deleterious mutation of tumor protein p53 (TP53). Our case suggests that while the prognosis for metastatic PDAC is poor, the population is nonetheless heterogeneous. Prognostic biomarkers are needed for the identification of patients for whom aggressive local treatment of oligometastatic PDAC may be warranted.
由于远处转移率高，传统上不主张对寡转移胰腺导管腺癌（PDAC）患者进行积极的局部治疗。我们描述了一名62岁男性，最初表现为可切除的PDAC，接受了Whipple手术，但在开始辅助吉西他滨治疗后的两个月内出现了多处肝转移。在治疗方案中加入了奥沙利铂，肝转移灶完全消退。他保持无病状态达五年，直到重新分期发现一个小的肺结节。该结节被切除，证实为转移性PDAC。在接受额外的辅助吉西他滨治疗后，患者在诊断为转移性疾病后12年无复发，最终因与胆肠吻合口狭窄相关的上行性胆管炎并发症去世。他去世时没有疾病复发的迹象。对肿瘤进行的二代测序未发现异常，仅显示KRAS激活突变和肿瘤蛋白p53（TP53）有害突变。我们的病例表明，虽然转移性PDAC的预后很差，但该群体仍然具有异质性。需要预后生物标志物来识别那些可能有必要对寡转移PDAC进行积极局部治疗的患者。
