Abstract
BackgroundPatients with potentially resectable pancreatic ductal adenocarcinoma (PDAC) are frequently found to be unresectable on exploration due to small distant metastasis. This study was to investigate predictors of small distant metastasis in patients with potentially resectable PDAC.MethodsPatients who underwent surgical exploration for potentially resectable PDAC from 2013 to 2014 were reviewed retrospectively and divided into two groups according to whether distant metastases were encountered on exploration. Then, univariate and multivariate logistic regression analyses were used to identify predictors of distant metastasis. A scoring system to predict distant metastasis of PDAC on exploration was constructed based on the regression coefficient of a multivariate logistic regression model.ResultsA total of 235 patients were included in this study. Mean age of the study population was 61.7 ± 10.4 years old. Upon exploration, distant metastases were found intraoperatively in 62 (26.4%) patients, while the remaining 173 were free of distant metastases. Multivariate logistic regression analysis identified that age ≤ 62 years old (p < 0.001), male sex (p = 0.011), tumor size ≥4.0 cm (p < 0.001), alanine aminotransferase level (ALT) < 125 U/L (p < 0.001), and carbohydrate antigen (CA19–9) level ≥ 385 U/mL (p < 0.001) were independent risk factors for occult distant metastasis of PDAC. A preoperative scoring system (0–8 points) for distant metastasis on exploration was constructed using these five factors. The receiver operating characteristic curves showed that the area under the curve of this score was 0.85. A score of 6 points was suggested to be the optimal cut-off value, and the sensitivity and specificity were 85% and 69%, respectively.ConclusionsDistant metastasis is still frequently encountered on exploration for patients with potentially resectable PDAC. Younger age, male sex, larger tumor size, low ALT level and high CA19–9 level are independent predictors of unexpected distant metastasis on exploration.
Highlights
Patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC) are frequently found to be unresectable on exploration due to small distant metastasis
Exclusion criteria were as follows: 1) patients underwent an operation with palliative intent, 2) patients without preoperative internal Multidetector computed tomography (MDCT), and 3) patients with distant metastasis detected with preoperative MDCT
By comparing a number of preoperative factors, this study identified that young age, male sex, low Alanine aminotransferase (ALT) level, large tumor size, and high CA 19–9 level were independent predictors of distant metastases in patients with resectable PDAC
Summary
Patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC) are frequently found to be unresectable on exploration due to small distant metastasis. This study was to investigate predictors of small distant metastasis in patients with potentially resectable PDAC. Multidetector computed tomography (MDCT) is currently the optimal imaging modality for preoperative diagnosis and staging of PDAC [7, 8]. This imaging modality has a poor sensitivity for identifying. Among the patients subjected to surgical exploration, a significant proportion (40%) of them are found to be unresectable due to occult distant metastasis or infiltration of local structures [10,11,12]. The proportion of patients successfully resected during surgical exploration might be as low as 50% [12, 13]
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