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Observational Study
. 2022 Apr 1;275(4):769-775.
doi: 10.1097/SLA.0000000000004093.

Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands: A Nationwide Analysis

Lois A Daamen  1   2 , Vincent P Groot  1 , Marc G Besselink  3 , Koop Bosscha  4 , Olivier R Busch  3 , Geert A Cirkel  5   6 , Ronald M van Dam  7 , Sebastiaan Festen  8 , Bas Groot Koerkamp  9 , Nadia Haj Mohammad  5 , Erwin van der Harst  10 , Ignace H J T de Hingh  11 , Martijn P W Intven  2 , Geert Kazemier  12 , Maartje Los  5 , Gert J Meijer  2 , Vincent E de Meijer  13 , Vincent B Nieuwenhuijs  14 , Bobby K Pranger  13 , Mihaela G Raicu  15 , Jennifer M J Schreinemakers  16 , Martijn W J Stommel  17 , Robert C Verdonk  18 , Helena M Verkooijen  19 , Izaak Quintus Molenaar  20 , Hjalmar C van Santvoort  20 ; Dutch Pancreatic Cancer Group
Affiliations
Observational Study

Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands: A Nationwide Analysis

Lois A Daamen et al. Ann Surg. .

Abstract

Objective: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival.

Summary of background data: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence.

Methods: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014-2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence.

Results: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001].

Conclusions: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.

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Conflict of interest statement

The authors report no conflicts of interest.

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References

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    1. Groot VP, Rezaee N, Wu W, et al. Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg 2018; 267:936–945.

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