Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Ann Surg Oncol. 2018 Aug;25(8):2475-2483. doi: 10.1245/s10434-018-6558-7. Epub 2018 Jun 14.
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.
在根治性切除胰腺导管腺癌（PDAC）后，约 80%的患者会出现疾病复发。目前尚不清楚复发部位在多大程度上具有预后意义。此外，对复发模式进行分层可能会深入了解 PDAC 的异质性生物学行为。
本研究旨在描述可切除 PDAC 患者的复发模式与生存之间的关系。
这项单中心队列研究纳入了 2000 年至 2013 年期间在约翰霍普金斯医院接受胰腺切除术的患者。排除标准为新辅助治疗和随访不完整。首先将复发部位分为 5 组，并使用 Kaplan-Meier 曲线估计生存结果。使用 Cox 比例风险模型分析特定复发部位与总生存期（OS）的关系，并进行带有和不带有里程碑分析。
877 例患者中有准确的随访数据，其中 662 例（75.5%）在最后一次随访时记录到复发。与肺（n=93）或局部（n=158）仅有复发相比，多部位（n=227，4.7 个月）或仅肝复发（n=166，7.2 个月）的患者在复发后的中位生存时间明显更差。多变量分析显示，独特的复发模式对 OS 具有不同的预测价值。以 12、18 和 24 个月为时间标记的里程碑分析证实了这些发现。
本研究表明，PDAC 的特定复发模式会导致不同的生存结果。此外，首次复发的不同部位对 OS 具有独特的独立预测价值，这有助于进行预后分层，并在诊断复发后决定治疗方案。
