TY - JOUR
T1 - Implications of the Pattern of Disease Recurrence on Survival Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma
AU - Groot, Vincent P.
AU - Gemenetzis, Georgios
AU - Blair, Alex B.
AU - Ding, Ding
AU - Javed, Ammar A.
AU - Burkhart, Richard A.
AU - Yu, Jun
AU - Borel Rinkes, Inne H.
AU - Molenaar, I. Quintus
AU - Cameron, John L.
AU - Fishman, Elliot K.
AU - Hruban, Ralph H.
AU - Weiss, Matthew J.
AU - Wolfgang, Christopher L.
AU - He, Jin
N1 - Funding Information:
ACKNOWLEDGEMENT The authors would like to thank the Foundation ‘‘De Drie Lichten’’, Prins Bernhard Cultuurfonds, VSB-fonds, Prof. Michaël-van Vloten Fonds, Nijbakker-Morra Foundation, and the Living With Hope Foundation (all from The Netherlands) for funding this study in the form of grants for a research fellowship by VPG.
Publisher Copyright:
© 2018, Society of Surgical Oncology.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: After radical resection of pancreatic ductal adenocarcinoma (PDAC), approximately 80% of patients will develop disease recurrence. It remains unclear to what extent the location of recurrence carries prognostic significance. Additionally, stratifying the pattern of recurrence may lead to a deeper understanding of the heterogeneous biological behavior of PDAC. Objective: The aim of this study was to characterize the relationship of recurrence patterns with survival in patients with resected PDAC. Methods: This single-center cohort study included patients undergoing pancreatectomy at the Johns Hopkins Hospital between 2000 and 2013. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. Sites of first recurrence were stratified into five groups and survival outcomes were estimated using Kaplan–Meier curves. The association of specific recurrence locations with overall survival (OS) was analyzed using Cox proportional-hazards models with and without landmark analysis. Results: Accurate follow-up data were available for 877 patients, 662 (75.5%) of whom had documented recurrence at last follow-up. Patients with multiple-site (n = 227, 4.7 months) or liver-only recurrence (n = 166, 7.2 months) had significantly worse median survival after recurrence when compared with lung- (n = 93) or local-only (n = 158) recurrence (15.4 and 9.7 months, respectively). On multivariable analysis, the unique recurrence patterns had variable predictive values for OS. Landmark analyses, with landmarks set at 12, 18, and 24 months, confirmed these findings. Conclusions: This study demonstrates that specific patterns of PDAC recurrence result in different survival outcomes. Furthermore, distinct first recurrence locations have unique independent predictive values for OS, which could help with prognostic stratification and decisions regarding treatment after the diagnosis of recurrence.
AB - Background: After radical resection of pancreatic ductal adenocarcinoma (PDAC), approximately 80% of patients will develop disease recurrence. It remains unclear to what extent the location of recurrence carries prognostic significance. Additionally, stratifying the pattern of recurrence may lead to a deeper understanding of the heterogeneous biological behavior of PDAC. Objective: The aim of this study was to characterize the relationship of recurrence patterns with survival in patients with resected PDAC. Methods: This single-center cohort study included patients undergoing pancreatectomy at the Johns Hopkins Hospital between 2000 and 2013. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. Sites of first recurrence were stratified into five groups and survival outcomes were estimated using Kaplan–Meier curves. The association of specific recurrence locations with overall survival (OS) was analyzed using Cox proportional-hazards models with and without landmark analysis. Results: Accurate follow-up data were available for 877 patients, 662 (75.5%) of whom had documented recurrence at last follow-up. Patients with multiple-site (n = 227, 4.7 months) or liver-only recurrence (n = 166, 7.2 months) had significantly worse median survival after recurrence when compared with lung- (n = 93) or local-only (n = 158) recurrence (15.4 and 9.7 months, respectively). On multivariable analysis, the unique recurrence patterns had variable predictive values for OS. Landmark analyses, with landmarks set at 12, 18, and 24 months, confirmed these findings. Conclusions: This study demonstrates that specific patterns of PDAC recurrence result in different survival outcomes. Furthermore, distinct first recurrence locations have unique independent predictive values for OS, which could help with prognostic stratification and decisions regarding treatment after the diagnosis of recurrence.
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U2 - 10.1245/s10434-018-6558-7
DO - 10.1245/s10434-018-6558-7
M3 - Article
C2 - 29948425
AN - SCOPUS:85048593177
SN - 1068-9265
VL - 25
SP - 2475
EP - 2483
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 8
ER -