Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns

doi:10.18632/oncotarget.5054

. 2015 Nov 3;6(34):36903-10.

doi: 10.18632/oncotarget.5054.

Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns

Tamna Wangjam^{1

2}, Zhe Zhang^{1

3}, Xian Chong Zhou^{1

3}, Laxmi Lyer^{1

4}, Farzana Faisal¹, Kevin C Soares^{1

5

3}, Elliott Fishman^{6

3}, Ralph H Hruban^{1

7

3

8}, Joseph M Herman^{1

9

3}, Daniel Laheru^{1

3

10}, Matthew Weiss^{1

5

3}, Min Li¹¹, Ana De Jesus-Acosta^{1

3

10}, Christopher L Wolfgang^{1

5

7

3

8}, Lei Zheng^{1

5

3

10

8}

Affiliations

¹ Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Division of Hematology and Oncology, University of Texas Health Science Center, San Antonio, TX, USA.
³ The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Hematology and Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ The Sol Goldman Pancreatic Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁹ Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁰ The Skip Viragh Center for Pancreatic Cancer, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹¹ University of Oklahoma Health Science Center, Oklahoma City, OK, USA.

PMID: 26372811
PMCID: PMC4742219
DOI: 10.18632/oncotarget.5054

Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns

Tamna Wangjam et al. Oncotarget. 2015.

. 2015 Nov 3;6(34):36903-10.

doi: 10.18632/oncotarget.5054.

Authors

Affiliations

¹ Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Division of Hematology and Oncology, University of Texas Health Science Center, San Antonio, TX, USA.
³ The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Hematology and Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ The Sol Goldman Pancreatic Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁹ Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁰ The Skip Viragh Center for Pancreatic Cancer, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹¹ University of Oklahoma Health Science Center, Oklahoma City, OK, USA.

PMID: 26372811
PMCID: PMC4742219
DOI: 10.18632/oncotarget.5054

Abstract

The majority of patients with curative resection of pancreatic ductal adenocarcinoma recur within 5 years of resection. However, the prognosis associated with different patterns of recurrence has not been well studied. A retrospective review of patients who underwent curative surgical resection of pancreatic cancer was performed. Of the 209 patients, 174 patients developed recurrent disease. Of these 174, 28(16.1%) had recurrent disease limited to lung metastases, 20(11.5%) had recurrence in the lung plus one or more other sites excluding the liver, 73(42.0%) had liver metastasis alone or liver metastasis with any other site except lung, 28(16.1%) local recurrence only, and 25(14.3%) peritoneal recurrence alone or together with local recurrence. Patients with recurrence limited to lung had a 8.5 months(Mo) median survival from recurrence to death, which was significantly better than the survival associated with recurrence in the liver(5.1Mo), in the peritoneum(2.3Mo) or locally(5.1Mo) in multivariable analyses. Among all groups, the time from surgery to the diagnosis of recurrence in patients who recurred in only in the lung was also the longest. However, 75% of patients were found to have indeterminate lung nodules on their surveillance CT scans prior to the diagnosis of recurrence in lung. This delayed diagnosis of lung recurrence may have a negative impact on survival after recurrence. In conclusion, pancreatic cancer with lung recurrence has a significantly better prognosis than recurrence in other sites. Further studies are needed to investigate how different diagnostic and treatment modalities affect the survival of this unique subpopulation of pancreatic cancer patients.

Keywords: lung metastasis; pancreatic cancer; prognosis; recurrent pattern.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have no relevant conflicts of interest to disclose.

Figures

**Figure 1. Kaplan-Meier analysis of the survival times (RTD) after different types of recurrence following surgical resection of pancreatic cancer**

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References

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[1] Wolfgang CL, Herman JM, Laheru DA, Klein AP, Erdek MA, Fishman EK, Hruban RH. Recent progress in pancreatic cancer. CA Cancer J Clin. 2013;63:318–48. - PMC - PubMed

[2] Wolfgang CL, Herman JM, Laheru DA, Klein AP, Erdek MA, Fishman EK, Hruban RH. Recent progress in pancreatic cancer. CA Cancer J Clin. 2013;63:318–48. - PMC - PubMed

[3] Herman JM, Swartz MJ, Hsu CC, Winter J, Pawlik TM, Sugar E, Robinson R, Laheru DA, Jaffee E, Hruban RH, Campbell KA, Wolfgang CL, Asrari F, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol. 2008;26:3503–10. - PMC - PubMed

[4] Herman JM, Swartz MJ, Hsu CC, Winter J, Pawlik TM, Sugar E, Robinson R, Laheru DA, Jaffee E, Hruban RH, Campbell KA, Wolfgang CL, Asrari F, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol. 2008;26:3503–10. - PMC - PubMed

[5] Sperti C, Pasquali C, Piccoli A, Pedrazzoli S. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg. 1997;21:195–200. - PubMed

[6] Sperti C, Pasquali C, Piccoli A, Pedrazzoli S. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg. 1997;21:195–200. - PubMed

[7] Hattangadi JA, Hong TS, Yeap BY, Mamon HJ. Results and patterns of failure in patients treated with adjuvant combined chemoradiation therapy for resected pancreatic adenocarcinoma. Cancer. 2009;115:3640–50. - PMC - PubMed

[8] Hattangadi JA, Hong TS, Yeap BY, Mamon HJ. Results and patterns of failure in patients treated with adjuvant combined chemoradiation therapy for resected pancreatic adenocarcinoma. Cancer. 2009;115:3640–50. - PMC - PubMed

[9] Van den Broeck A, Sergeant G, Ectors N, Van Steenbergen W, Aerts R, Topal B. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2009;35:600–4. - PubMed

[10] Van den Broeck A, Sergeant G, Ectors N, Van Steenbergen W, Aerts R, Topal B. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2009;35:600–4. - PubMed

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Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns

Affiliations

Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns

Authors

Affiliations

Abstract

Conflict of interest statement

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