Andel Paul C M, van Goor Iris W J M, Augustinus Simone, Berrevoet Frederik, Besselink Marc G, Bhojwani Rajesh, Boggi Ugo, Bouwense Stefan A W, Cirkel Geert A, van Dam Jacob L, Djanani Angela, Dorcaratto Dimitri, Dreyer Stephan, den Dulk Marcel, Frigerio Isabella, Ghorbani Poya, Goetz Mara R, Groot Koerkamp Bas, Gryspeerdt Filip, Hidalgo Salinas Camila, Intven Martijn, Izbicki Jakob R, Jorba Martin Rosa, Kauffmann Emanuele F, Klug Reinhold, Liem Mike S L, Luyer Misha D P, Maglione Manuel, Martin-Perez Elena, Meerdink Mark, de Meijer Vincent E, Nieuwenhuijs Vincent B, Nikov Andrej, Nunes Vitor, Pando Elizabeth, Radenkovic Dejan, Roeyen Geert, Sanchez-Bueno Francisco, Serrablo Alejandro, Sparrelid Ernesto, Tepetes Konstantinos, Thakkar Rohan G, Tzimas George N, Verdonk Robert C, Ten Winkel Meike, Zerbi Alessandro, Groot Vincent P, Molenaar I Quintus, Daamen Lois A, van Santvoort Hjalmar C
Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St Antonius Hospital Nieuwegein, Utrecht, the Netherlands.
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
JAMA Surg. 2025 Jan 1;160(1):74-84. doi: 10.1001/jamasurg.2024.5024.
International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide.
To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).
DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging.
Symptomatic follow-up or routine imaging in patients who underwent PDAC resection.
Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS.
Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04).
In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.
国际指南在关于胰腺导管腺癌（PDAC）切除术后随访中的常规影像学检查建议方面缺乏一致性。因此，全球各中心的随访策略存在差异。
比较在欧洲 - 非洲肝脏 - 胰腺 - 胆管协会（E - AHPBA）所属国际中心接受胰腺切除术后出现症状时进行随访或常规影像学检查的PDAC复发患者的临床结局，包括以复发为重点的治疗和生存率。
设计、设置和参与者：这是一项前瞻性、国际性横断面研究。纳入了2020年至2021年间来自13个国家共33个E - AHPBA中心的患者。根据预先定义的研究方案，前瞻性纳入接受PDAC切除并被诊断为疾病复发的患者。患者根据术后随访策略分层：症状性随访（即不进行常规影像学检查）或常规影像学检查。
接受PDAC切除患者的症状性随访或常规影像学检查。
采用Kaplan - Meier曲线估计总生存期（OS），并使用对数秩检验进行比较。为调整潜在混杂因素，采用多变量逻辑回归评估随访策略与以复发为重点的治疗之间的关联。采用多变量Cox比例风险分析研究随访策略与OS之间的独立关联。
总体而言，纳入了333例PDAC复发患者（平均[标准差]年龄为65[11]岁；184例男性[55%]）。在纳入最后一名患者2年后进行分析时，中位（四分位间距）随访时间为40（30 - 58）个月。在整个队列中，98例患者（29%）接受症状性随访，235例患者（71%）接受常规影像学检查。接受症状性随访组与常规影像学检查组的OS分别为23个月（95%置信区间，19 - 29个月）和28个月（95%置信区间，24 - 30个月）（P = 0.01）。常规影像学检查与接受以复发为重点的治疗相关（调整后的优势比，2.57；95%置信区间，1.22 - 5.41；P = 0.01）以及OS延长（调整后的风险比，0.75；95%置信区间，0.56 - 0.99；P = 0.04）。
在这项国际性、前瞻性横断面研究中，PDAC胰腺切除术后的常规随访影像学检查与接受以复发为重点的治疗和OS延长独立相关。
