Early and late recurrence patterns of pancreatic ductal adenocarcinoma after pancreaticoduodenectomy: a multicenter study

Abstract

Background: Survival after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains poor because of high incidences of recurrence. The risk factors, patterns, and long-term prognosis in patients with early recurrence and late recurrence (ER and LR) for PDAC after PD were studied. Methods: Data from patients who underwent PD for PDAC were analyzed. Recurrence was divided into ER (ER ≤1 years) and LR (LR >1 years) using the time to recurrence after surgery. Characteristics and patterns of initial recurrence, and postrecurrence survival (PRS) were compared between patients with ER and LR. Results: Among the 634 patients, 281 (44.3%) and 249 (39.3%) patients developed ER and LR, respectively. In the multivariate analysis, preoperative CA19-9 levels, resection margin status, and tumor differentiation were significantly associated with both ER and LR, while lymph node metastasis and perineal invasion were associated with LR. Patients with ER, when compared with patients with LR, showed a significantly higher proportion of liver-only recurrence (P<0.05), and worse median PRS (5.2 vs. 9.3 months, P<0.001). Lung-only recurrence had a significantly longer PRS when compared with liver-only recurrence (P<0.001). Multivariate analysis demonstrated that ER and irregular postoperative recurrence surveillance were independently associated with a worse prognosis (P<0.001). Conclusion: The risk factors for ER and LR after PD are different for PDAC patients. Patients who developed ER had worse PRS than those who developed LR. Patients with lung-only recurrence had a significantly better prognosis than those with other recurrent sites.

Interval to Recurrence Affects Survival in Recurrent Head and Neck Squamous Cell Carcinoma

“…Previous studies demonstrating the association between the interval to recurrence and clinical outcomes mainly arose after radical resection to recurrence in other carcinomas [6][7][8][9][10] and HNSCC [12,21]. In all reports, patients with ER had a significantly worse prognosis than those with LR.…”

“…Interestingly, the interval to recurrence after radical resection has been reported to be associated with clinical outcomes in certain malignant tumors. In gastric [6], liver [7], pancreatic [8], kidney [9], and esophageal [10] cancers, early recurrence (ER) after radical resection has a poorer prognosis than late recurrence (LR). Even in HNSCC, an association between recurrence timing and patient survival has been reported [11][12][13]; however, investigations are insufficient.…”

Comparison of prognosis and postoperative morbidities between standard pancreaticoduodenectomy and the TRIANGLE technique for resectable pancreatic ductal adenocarcinoma

“…Approximately 70% of patients resected will suffer from recurrence within 2 years[ 5 ], and 25%-45% of patients with PDAC experience local recurrence following surgical resection[ 6 , 7 ]. To date, there have been a number of prognostic factors identified for recurrence and survival, and positive resection margin has been identified as one of the major factors in terms of local and overall recurrence[ 8 ]. Therefore, standardized concepts of radical resection should aim to achieve complete tumor clearance and prevent local recurrence.…”

Influence of sarcopenia on postoperative complications and long-term survival in pancreatic cancer patients undergone pancreaticoduodenectomy

“…The increasing incidence rate and the younger population of patients pose a serious challenge to the comprehensive and individualized treatment of PC and to improve the outcomes. For the long-term prognosis of PC patients after pancreatoduodenectomy (PD), many studies focus on the clinicopathological characteristics, including tumor differentiation, vascular invasion, lymph node metastasis and tumor size ( 3 , 4 ). However, to predict the prognosis of patients with PC after PD, the predictive ability of the above clinicopathological characteristics can no longer be further improved, and it is slightly insufficient to consider only the clinicopathological characteristics.…”