Abstract
Recurrence and distant metastases were main reasons of unfavorable outcomes for patients with pancreatic ductal adenocarcinoma (PDAC) after surgery. The aim of this study was to describe the patterns, timing, and predictors of recurrence or metastasis in PDAC patients after curative surgery. Patients with PDAC who underwent radical pancreatectomy were included. Associations between clinicopathological and radiological characteristics and specific pattern of progression were investigated. Least absolute shrinkage and selection operator (LASSO) and Cox regression were applied to assess the prognostic factors for overall survival (OS) and progression-free survival (PFS). A total of 302 patients were included into present study, and 173 patients were documented as recurrence after a median survival of 24.7 months. More than half of patients recurred after 12 months after surgery, and the liver was the most common metastatic site. Decreased time interval to progression, elevated carbohydrate antigen 19-9 (CA19-9) level, and lymph node (LN)16 metastasis were independent predictors for reduced OS. Independent prognostic factors for PFS included elevated carcinoembryonic antigen (CEA) level, local progression, liver or lung-only metastasis, local + distant progression, multiple metastases, LN16 metastasis, imaging tumor size, chemotherapy, and tumor–node–metastasis (TNM) stage. The predictive system showed valuable prediction performance with values of concordance indexes (C-indexes) and the area under the receiver operating characteristic curve (AUC) over 0.80. Different survival curves and predictive factors for specific patterns of disease progression suggested the biological heterogeneity, providing new versions into personal management of recurrence in PDAC patients after surgery.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease and is predicted to become the second leading cause of cancer-specific death by 2030 [1]
Recurrence was observed in 57.3% of patients
68.2% of recurrences occurred at a distant site, illustrating that there were systemic diseases in these patients at the time of surgery
Summary
Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease and is predicted to become the second leading cause of cancer-specific death by 2030 [1]. Surgery followed by adjuvant chemotherapy has been widely established as the best mean to obtain longer survival. This combination therapy can only be applied to 20% of patients, whereas most patients suffered from locally. Predicting Recurrence Risk of PDAC invasion, perineural invasion, adjacent organ invasion, and satellite foci. LN ratio (LNR) was defined as the number of LNs with metastases divided by the total number of excised. LNs. Several radiological variables, including imaging tumor size, LN metastasis, vascular invasion, and LN size, were analyzed.
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