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. 2018 Aug;25(8):2475-2483.
doi: 10.1245/s10434-018-6558-7. Epub 2018 Jun 14.

Implications of the Pattern of Disease Recurrence on Survival Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma

Vincent P Groot  1   2 , Georgios Gemenetzis  1 , Alex B Blair  1 , Ding Ding  1 , Ammar A Javed  1 , Richard A Burkhart  1 , Jun Yu  1 , Inne H Borel Rinkes  2 , I Quintus Molenaar  2 , John L Cameron  1 , Elliot K Fishman  3 , Ralph H Hruban  4 , Matthew J Weiss  1 , Christopher L Wolfgang  1 , Jin He  5
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Implications of the Pattern of Disease Recurrence on Survival Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma

Vincent P Groot et al. Ann Surg Oncol. 2018 Aug.

Abstract

Background: After radical resection of pancreatic ductal adenocarcinoma (PDAC), approximately 80% of patients will develop disease recurrence. It remains unclear to what extent the location of recurrence carries prognostic significance. Additionally, stratifying the pattern of recurrence may lead to a deeper understanding of the heterogeneous biological behavior of PDAC.

Objective: The aim of this study was to characterize the relationship of recurrence patterns with survival in patients with resected PDAC.

Methods: This single-center cohort study included patients undergoing pancreatectomy at the Johns Hopkins Hospital between 2000 and 2013. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. Sites of first recurrence were stratified into five groups and survival outcomes were estimated using Kaplan-Meier curves. The association of specific recurrence locations with overall survival (OS) was analyzed using Cox proportional-hazards models with and without landmark analysis.

Results: Accurate follow-up data were available for 877 patients, 662 (75.5%) of whom had documented recurrence at last follow-up. Patients with multiple-site (n = 227, 4.7 months) or liver-only recurrence (n = 166, 7.2 months) had significantly worse median survival after recurrence when compared with lung- (n = 93) or local-only (n = 158) recurrence (15.4 and 9.7 months, respectively). On multivariable analysis, the unique recurrence patterns had variable predictive values for OS. Landmark analyses, with landmarks set at 12, 18, and 24 months, confirmed these findings.

Conclusions: This study demonstrates that specific patterns of PDAC recurrence result in different survival outcomes. Furthermore, distinct first recurrence locations have unique independent predictive values for OS, which could help with prognostic stratification and decisions regarding treatment after the diagnosis of recurrence.

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Conflict of interest statement

DISCLOSURES Vincent P. Groot, Georgios Gemenetzis, Alex B. Blair, Ding Ding, Ammar A. Javed, Richard A. Burkhart, Jun Yu, Inne H. Borel Rinkes, I. Quintus Molenaar, John L. Cameron, Elliot K. Fishman, Ralph H. Hruban, Matthew J. Weiss, Christopher L. Wolfgang, and Jin He have no financial disclosures or conflicts of interest to declare.

Figures

FIG. 1
FIG. 1
Kaplan–Meier curves showing SAR for different recurrence patterns with pairwise comparison of SAR using the log-rank test. For clarity, the curve for ‘other’ recurrence has been omitted
FIG. 2
FIG. 2
Kaplan–Meier curves showing OS for different recurrence patterns with pairwise comparison of OS using the log-rank test. For clarity, the curve for ‘other’ recurrence has been omitted
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