Recurrence Patterns and Survival Outcomes after Multidisciplinary Treatment of Pancreatic Cancer

Abstract

INTRODUCTION: The aim of this retrospective study was to determine whether change in neoadjuvant therapy affected patterns of recurrence after operation among patients with pancreatic ductal adenocarcinoma (PDAC) throughout the past 2 decades. METHODS: Patients who received any neoadjuvant therapy followed by pancreatectomy for PDAC at our institution from 1998 to 2018 were identified. Treatment strategy, recurrence site and timing, and survival outcomes were compared between time periods (1998 to 2004, 2005 to 2011, 2012 to 2018). RESULTS: We included 728 patients (205, 251, and 272 patients, respectively). The proportion of patients with borderline resectable or locally advanced tumor increased over time (11%, 30%, and 42%). Chemotherapy use increased over time (37%, 67%, 75%); ~90% received a gemcitabine-based non–nab-paclitaxel regimen in the first 2 periods, and 55% received FOLFIRINOX and 25% received gemcitabine/nab-paclitaxel in the 3rd period. (Chemo)radiation therapy use decreased (95%, 82%, 81%) and overall survival (OS) improved (median 24, 28, 31 months) over time. Despite similar incidence of recurrence across periods (66% to 69%), when the 3rd period was compared with other periods, conditional risk of recurrence (recurrence among disease-free survivors yearly) appeared to be shifted from the first to second and third years and was uncommon (<5%) after the 3rd year (Figure). Treatment in the 3rd period was independently associated with improved OS (hazard ratio [HR] 0.67; p = 0.008) and OS after recurrence (HR 0.63; p = 0.003).FigureCONCLUSION: Despite increase in borderline resectable and locally advanced cases, OS improved over time. Despite stable recurrence patterns overall, conditional risk of recurrence changed over time, which should be considered in postoperative surveillance plans.