Mahamid Nedaa, Jacover Arielle, Zabeda Angam, Beller Tamar, Murad Havi, Elizur Yoav, Pery Ron, Eshkenazy Rony, Golan Talia, Nachmany Ido, Pencovich Niv
Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv 69978, Israel.
Institue of Oncology, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv 69978, Israel.
J Clin Med. 2025 Aug 6;14(15):5538. doi: 10.3390/jcm14155538.
Pancreatic adenocarcinoma (PDAC) with liver oligometastases (LOM) presents a therapeutic challenge, with optimal management strategies remaining uncertain. This study evaluates the long-term outcomes, patterns of disease progression, and potential factors influencing prognosis in this patient subset. Patients diagnosed with PDAC and LOM were retrospectively analyzed. Disease progression patterns, causes of death, and predictors of long-term outcomes were assessed. Among 1442 patients diagnosed with metastatic PDAC between November 2009 and July 2024, 129 (9%) presented with LOM, defined as ≤3 liver lesions each measuring <2 cm. Patients with LOM had significantly improved overall survival (OS) compared to those with high-burden disease ( = 0.026). The cause of death (local regional disease vs. systemic disease) could be determined in 74 patients (57%), among whom age at diagnosis, history of smoking, and white blood cell (WBC) count differed significantly between groups. However, no significant difference in OS was observed between the two groups ( = 0.64). Sixteen patients (22%) died from local complications of the primary tumor, including 6 patients (7%) who showed no evidence of new or progressive metastases. In competing risk and multivariable analysis, a history of smoking remained the only factor significantly associated with death due to local complications. Approximately one in five patients with PDAC-LOM died from local tumor-related complications-some without metastatic progression-highlighting a potential role for surgical intervention. Further multicenter studies are warranted to refine diagnostic criteria and better identify patients who may benefit from surgery.
伴有肝脏寡转移（LOM）的胰腺腺癌（PDAC）是一项治疗挑战，最佳管理策略仍不明确。本研究评估了该患者亚组的长期预后、疾病进展模式以及影响预后的潜在因素。对诊断为PDAC和LOM的患者进行了回顾性分析。评估了疾病进展模式、死亡原因和长期预后的预测因素。在2009年11月至2024年7月期间诊断为转移性PDAC的1442例患者中，129例（9%）表现为LOM，定义为每个肝脏病变≤3个，每个病变<2 cm。与高负荷疾病患者相比，LOM患者的总生存期（OS）显著改善（P = 0.026）。74例患者（57%）可确定死亡原因（局部区域疾病与全身疾病），其中两组在诊断时的年龄、吸烟史和白细胞（WBC）计数存在显著差异。然而，两组之间的OS未观察到显著差异（P = 0.64）。16例患者（22%）死于原发性肿瘤的局部并发症，其中6例（7%）没有新的或进展性转移的证据。在竞争风险和多变量分析中，吸烟史仍然是与局部并发症导致死亡显著相关的唯一因素。约五分之一的PDAC-LOM患者死于局部肿瘤相关并发症，有些患者没有转移进展，这突出了手术干预的潜在作用。有必要进行进一步的多中心研究，以完善诊断标准并更好地识别可能从手术中获益的患者。
