Can Surgical Resection of Metastatic Lesions Be Beneficial to Pancreatic Ductal Adenocarcinoma Patients with Isolated Lung Metastasis?

Abstract

In the era of effective chemotherapy on pancreatic ductal adenocarcinoma (PDAC) with distant metastasis, data on the effects of metastatectomy are lacking. So, we investigated the effect of metastatectomy on survival after metastasis in PDAC patients with isolated lung metastasis. This retrospective study analyzed 1342 patients who were histologically diagnosed with PDAC with distant metastasis from January 2007 to December 2018, of which 83 patients had isolated pulmonary metastasis. Additionally, 4263 patients were extracted from the National Cancer Database (NCDB) and analyzed. Log-rank test and Kaplan−Meier survival analysis were used to analyze survival after metastasis. The five-year survival rate was significantly higher in patients who underwent pulmonary metastatectomy than in those who received only chemotherapy or supportive treatment (60.6% vs. 6.2% vs. 0.0%, p < 0.001). A similar trend was observed in the NCDB (two-year survival rate, 27.4% vs. 15.8% vs. 4.7%, p < 0.001). In the multivariate analysis, lung lesion multiplicity (hazard ratio (HR) = 2.004, p = 0.017), metastatectomy (HR = 0.278, p = 0.036), chemotherapy (HR = 0.434, p = 0.024), and chemotherapy cycles (HR = 0.300, p < 0.001) had significant effects on survival. Metastatectomy with primary pancreatic lesions is recommended with effective chemotherapy in PDAC patients with isolated lung metastasis.

Keywords: chemotherapy; metastasis/lung; metastatectomy; pancreatic ductal adenocarcinoma; survival.

Figure 1

Flow diagram of the study with 83 patients who were histologically diagnosed as having pancreatic ductal adenocarcinoma with isolated pulmonary metastasis between January 2007 and December 2018.

Figure 2

National Cancer Database mining strategy.

Figure 3

(a) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with distant metastasis according to metastatic sites. (b) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis according to the temporal metastatic pattern. (c) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis according to multiplicity of lung lesions. M.S.T., median survival time; YSR, year survival rate.

Figure 3

(a) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with distant metastasis according to metastatic sites. (b) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis according to the temporal metastatic pattern. (c) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis according to multiplicity of lung lesions. M.S.T., median survival time; YSR, year survival rate.

Figure 4

(a) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis according to treatment options. (b) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis who did not undergo metastatectomy according to a chemotherapy regimen. CTx., chemotherapy; BSC, best supportive care; M.S.T., median survival time; YSR, year survival rate; FOLFIRINOX, fluorouracil plus leucovorin, irinotecan, and oxaliplatin; GEM/Ab, gemcitabine plus albumin-bound paclitaxel; GEM combi, gemcitabine combined with agents other than albumin-bound paclitaxel; GEM mono, gemcitabine monotherapy.

Figure 5

(a) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis from the National Cancer Database according to treatment options. (b) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis from the National Cancer Database who did not undergo surgery according to a chemotherapy regimen. CTx., chemotherapy; BSC, best supportive care; M.S.T, median survival time; YSR, year survival rates.

Figure 5

(a) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis from the National Cancer Database according to treatment options. (b) Kaplan−Meier analysis of pancreatic ductal adenocarcinoma patients with isolated lung metastasis from the National Cancer Database who did not undergo surgery according to a chemotherapy regimen. CTx., chemotherapy; BSC, best supportive care; M.S.T, median survival time; YSR, year survival rates.