Patterns of recurrence and outcomes in pancreatic cancer.

Abstract

234 Background: There is limited evidence supporting improved overall survival in patients with pancreatic cancer with isolated lung metastases compared to other metastatic sites. We reviewed our experience with patterns of metastases and outcomes in pancreatic cancer. Methods: A retrospective review of 378 patients who underwent potentially curative pancreatic resection for pancreatic adenocarcinoma at a tertiary care cancer center between 1997-2010. All patients were restaged in accordance with AJCC 7th edition guidelines. Kaplan-Meier analysis with log-rank test and Cox regression was used to compare median overall and disease-free survival (OS and DFS). Results: Patients were divided into 8 groups based upon site of first recurrence. 40% of patients were without evidence of recurrence at time of last follow up (n=165). Sites of first recurrence are as follow: liver (n=93, 24.6%), lung (n=37, 9.8%), locoregional (n=49, 13%), peritoneum (n=17, 4.5%), bone (n=6, 1.6%), and distant (n=2, 0.5%). 23 patients (6.1%) presented with multiple sites as first recurrence. Patients with isolated lung metastases had longest median OS while those with liver metastases had the shortest median OS (32 months vs. 17 months, p<0.001). Time to recurrence for lung vs. liver metastases was 14.9 vs. 7.4 months (p<0.005). Patients with liver metastases uniformly had significantly worse median OS as compared to other sites of recurrence. Finally, with respect to isolated lung recurrences, only CA19-9 was a significant prognostic factor. Those patients with a CA19-9 at diagnosis >185 had a 5-fold greater risk of death in our length of follow-up. Conclusions: Pancreatic cancer patients with isolated lung metastases as the site of first recurrence have improved OS compared to other sites, while patients with liver metastases have worse OS. CA19-9 >185 at time of diagnosis among patients with isolated lung recurrences was predictive for worse outcomes.