Prognostication for recurrence patterns after curative resection for pancreatic ductal adenocarcinoma
- Author:
Andrew ANG
1
;
Athena MICHAELIDES
;
Claude CHELALA
;
Dayem ULLAH
;
Hemant M. KOCHER
;
Author Information
- Publication Type:Original Article
- From: Annals of Hepato-Biliary-Pancreatic Surgery 2024;28(2):248-261
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:s/Aims: This study aimed to investigate patterns and factors affecting recurrence after curative resection for pancreatic ductal adenocarcinoma (PDAC).
Methods:Consecutive patients who underwent curative resection for PDAC (2011-21) and consented to data and tissue collection (Barts Pancreas Tissue Bank) were followed up until May 2023. Clinico-pathological variables were analysed using Cox proportional hazards model.
Results:Of 91 people (42 males [46%]; median age, 71 years [range, 43–86 years]) with a median follow-up of 51 months (95% confidence intervals [CIs], 40–61 months), the recurrence rate was 72.5% (n = 66; 12 loco-regional alone, 11 liver alone, 5 lung alone, 3 peritoneal alone, 29 simultaneous loco-regional and distant metastases, and 6 multi-focal distant metastases at first recurrence diagnosis).The median time to recurrence was 8.5 months (95% CI, 6.6–10.5 months). Median survival after recurrence was 5.8 months (95% CI, 4.2–7.3 months). Stratification by recurrence location revealed significant differences in time to recurrence between loco-regional only recurrence (median, 13.6 months; 95% CI, 11.7–15.5 months) and simultaneous loco-regional with distant recurrence (median, 7.5 months; 95% CI, 4.6–10.4 months; p = 0.02, pairwise log-rank test). Significant predictors for recurrence were systemic inflammation index (SII) ≥ 500 (hazard ratio [HR], 4.5; 95% CI, 1.4–14.3), lymph node ratio ≥ 0.33 (HR, 2.8; 95% CI, 1.4–5.8), and adjuvant chemotherapy (HR, 0.4; 95% CI, 0.2–0.7).
Conclusions:Timing to loco-regional only recurrence was significantly longer than simultaneous loco-regional with distant recurrence. Significant predictors for recurrence were SII, lymph node ration, and adjuvant chemotherapy.
