Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.197, Rui Jin Er Road, Shanghai, 200025, China.
Research Institute of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
BMC Cancer. 2022 Jun 13;22(1):649. doi: 10.1186/s12885-022-09719-6.
Prognosis for patients recurred rapidly after resection of pancreatic ductal adenocarcinoma (PDAC) was extremely poor. We proposed the concept of postoperative hyper-progression disease (PO-HPD) to define recurrence within 2 months after surgery, explored the role of surgery for postoperative HPD patients and determined the predictive preoperative risk factors and genomic features of PO-HPD.
976 patients undergoing curative resection of PDAC were enrolled. Survival data of 1733 stage IV patients from the US Surveillance, Epidemiology and End Results database was also collected. Patients relapsed were grouped into 3 groups regarding of the recurrence time (within 2 months were PO-HPD, within 2 to 12 months were early recurrence (ER) and within > 12 months were late recurrence (LR)). Risk factors for PO-HPD were explored with logistic regression models. Genomic features of 113 patients were investigated using next-generation sequencing-based gene panel testing.
718 of 976 cases relapsed, 101were PO-HPD, 418 were ER and 199 were LR. Total survival of PO-HPD was 12.5 months, shorter than that of ER (16.7 months) and LR (35.1 months), and verged on that of stage IV patients (10.6 months). Preoperative risk factors for PO-HPD included red blood cell count < 3.94*10^12/L, CA19-9 ≥ 288.6 U/mL, CA125 ≥ 22.3 U/mL and tumor size≥3.45 cm. Mutations of CEBPA, ATR and JAK1 were only identified in PO-HPD and they owned lower level of CN gain compared to others.
Prognosis of PO-HPD was extremely poor and the role of surgery for PO-HPD should be prudently assessed.
胰腺导管腺癌（PDAC）患者术后快速复发的预后极差。我们提出了术后高进展疾病（PO-HPD）的概念，以定义术后 2 个月内的复发，探讨了手术对术后 HPD 患者的作用，并确定了 PO-HPD 的术前预测风险因素和基因组特征。
纳入 976 例接受 PDAC 根治性切除术的患者。还收集了美国监测、流行病学和最终结果数据库中 1733 例 IV 期患者的生存数据。根据复发时间将复发患者分为 3 组（2 个月内为 PO-HPD，2-12 个月内为早期复发（ER），>12 个月为晚期复发（LR））。使用逻辑回归模型探讨 PO-HPD 的危险因素。使用基于下一代测序的基因面板检测对 113 例患者进行了基因组特征分析。
976 例中有 718 例复发，101 例为 PO-HPD，418 例为 ER，199 例为 LR。PO-HPD 的总生存率为 12.5 个月，短于 ER（16.7 个月）和 LR（35.1 个月），接近于 IV 期患者（10.6 个月）。PO-HPD 的术前危险因素包括红细胞计数<3.94*10^12/L、CA19-9≥288.6 U/mL、CA125≥22.3 U/mL 和肿瘤大小≥3.45 cm。CEBPA、ATR 和 JAK1 的突变仅在 PO-HPD 中发现，与其他患者相比，它们的 CN 增益水平较低。
PO-HPD 的预后极差，应谨慎评估手术对 PO-HPD 的作用。
