Influence of recurrence's locations of pancreatic adenocarcinoma on patient survival

Abstract

Introduction: The recurrence of invasive pancreatic ductal adenocarcinomas (PDAC) is related to a poor prognosis. The aim of this study is to compare patient survival rates with different recurrence's locations. Methods: A review was carried out of a prospectively maintained database with consecutive patients who underwent radical surgery for PDAC from January 2007 to December 2016. We analysed variables related to the appearance of recurrence and prognosis. Univariate analysis of interval from recurrence to death (IRD) was performed for each location. Results: 67 patients underwent pancreatectomy, with a median follow-up of 24.7 months. Recurrence appeared in 48 patients (71.6%) with a mean disease-free survival and overall survival rate of 21.5 and 10.5 months, respectively. The mean IRD was 9.2 months. A Whipple procedure was performed in 91.6% of patients, with venous resection in 37.5%. Adjuvant chemotherapy was given to 72.9% of patients. A positive microscopic margin was present in 43.8% and poor differentiation in 27.1%. There was lymphovascular and perineural invasion in 47.9% and 70.8%, respectively. The recurrence locations were: liver (39.6%), local (31.3%), lung (10.4%), bone (6.3%) and peritoneum (4.2%); 8.3% of recurrences occurred as disseminated disease (≥2 locations). IRD related to bone recurrences was significantly shorter when compared to the other locations (9.6 vs. 3.7 months; p = 0.004), while hepatic recurrences showed a longer IRD (7.6 vs. 12.0 months; p = 0.045). Conclusion: Bone recurrences in PDAC present shorter IRD, while hepatic recurrences show a longer interval.