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

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgement

The authors would like to thank the Foundation “De Drie Lichten”, Prins Bernhard Cultuurfonds, VSBfonds, Prof. Michaël-van Vloten Fonds, Nijbakker-Morra Foundation, and the Living With Hope Foundation (all from The Netherlands) for funding this study in the form of grants for a research fellowship by VPG.

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.

Author information

Authors and Affiliations

  1. Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Vincent P. Groot MD, Georgios Gemenetzis MD, Alex B. Blair MD, Ding Ding MD, MS, Ammar A. Javed MD, Richard A. Burkhart MD, Jun Yu MD, PhD, John L. Cameron MD, FACS, Matthew J. Weiss MD, FACS, Christopher L. Wolfgang MD, PhD, FACS & Jin He MD, PhD, FACS

  2. Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands

    Vincent P. Groot MD, Inne H. Borel Rinkes MD, PhD & I. Quintus Molenaar MD, PhD

  3. Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Elliot K. Fishman MD

  4. Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ralph H. Hruban MD

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  1. Vincent P. Groot MD
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  15. Jin He MD, PhD, FACS
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Corresponding author

Correspondence to Jin He MD, PhD, FACS.

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Groot, V.P., Gemenetzis, G., Blair, A.B. et al. Implications of the Pattern of Disease Recurrence on Survival Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 25, 2475–2483 (2018). https://doi.org/10.1245/s10434-018-6558-7

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  • DOI: https://doi.org/10.1245/s10434-018-6558-7

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