Department of Surgery, LaBahn Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI.
Division of Gastroenterology, Department of Medicine, LaBahn Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI.
Surgery. 2020 Sep;168(3):440-447. doi: 10.1016/j.surg.2020.04.031. Epub 2020 Jul 5.
More than 70% of patients with localized pancreatic cancer treated with upfront surgery develop disease recurrence. Herein we describe the radiographic patterns and timing of disease recurrence after neoadjuvant therapy and surgery in patients with pancreatic cancer.
Radiographic patterns of first disease recurrence were examined in patients with localized pancreatic cancer who completed neoadjuvant therapy and surgery. Disease recurrence was classified as local (pancreas, resection bed, or peripancreatic vasculature); regional (peritoneum or abdominal wall); or distant (liver, lung, bone). Progression-free survival was calculated from the date of diagnosis to the date of recurrence.
Of 306 consecutive patients who completed neoadjuvant therapy and surgery, 149 (49%) had resectable pancreatic cancer and 157 (51%) had borderline resectable disease. Neoadjuvant therapy consisted of chemoradiation (32%), chemotherapy (14%), or both therapies (54%). Overall, primary therapy (including preoperative and postoperative therapy) consisted of chemoradiation alone in 29 (9%), chemotherapy alone in 14 (5%), and both therapies in 263 (86%) patients. At a median follow-up of 27 months, 186 (61%) of the 306 patients had recurrent pancreatic cancer. Sites of first recurrence were local-only in 29 (9%), regional-only in 19 (6%), distant-only in 87 (28%), and multisite in 51 (17%). The overall median progression-free survival for all patients was 24 months. Neoadjuvant chemoradiation reduced the odds of local-only recurrence (odds ratio: 0.21; 95% confidence interval: 0.06-0.77; P = .02).
After neoadjuvant therapy and surgery, 9% of patients were found to have local-only recurrence. Treatment sequencing that incorporates neoadjuvant chemoradiation may improve local disease control.
超过 70%接受初始手术治疗的局限性胰腺癌患者会出现疾病复发。在此，我们描述了接受新辅助治疗和手术治疗的胰腺癌患者疾病复发的影像学模式和时间。
检查了完成新辅助治疗和手术的局限性胰腺癌患者的首次疾病复发的影像学模式。疾病复发分为局部（胰腺、切除床或胰周血管）；区域（腹膜或腹壁）；或远处（肝脏、肺、骨骼）。无进展生存期从诊断日期计算至复发日期。
在 306 例连续完成新辅助治疗和手术的患者中，149 例（49%）为可切除胰腺癌，157 例（51%）为边界可切除疾病。新辅助治疗包括放化疗（32%）、化疗（14%）或两种治疗方法（54%）。总体而言，29 例（9%）患者的初始治疗（包括术前和术后治疗）仅采用放化疗，14 例（5%）患者仅采用化疗，263 例（86%）患者采用两种治疗方法。中位随访 27 个月时，306 例患者中有 186 例（61%）出现复发性胰腺癌。首次复发部位为局部的有 29 例（9%），区域的有 19 例（6%），远处的有 87 例（28%），多部位的有 51 例（17%）。所有患者的总体中位无进展生存期为 24 个月。新辅助放化疗降低了局部复发的几率（比值比：0.21；95%置信区间：0.06-0.77；P=0.02）。
在新辅助治疗和手术后，9%的患者出现局部复发。包含新辅助放化疗的治疗序贯可能改善局部疾病控制。
