Identifying Clinical Factors Which Predict for Early Failure Patterns Following Resection for Pancreatic Adenocarcinoma in Patients Who Received Adjuvant Chemotherapy Without Chemoradiation

Walston, Steve; Salloum, Joseph; Grieco, Carmine R.; Wuthrick, Evan; Diaz, Dayssy Alexandra; Barney, C.; Manilchuk, Andrei; Schmidt, C. Max; Dillhoff, Mary; Pawlik, Timothy M.; Williams, Terence M.

doi:10.1097/coc.0000000000000452

Cited by 8 publications

(10 citation statements)

References 32 publications

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“…The weighted median OS in 13 studies was 19·8 (range 14·0–30·0) months for LR recurrence, 15·0 (10·0–17·7) months for liver recurrence, 30·4 (24·1–40·3) months for lung recurrence and 14·1 (5·5–17·0) months for PeD ( Fig . ).…”

Section: Resultsmentioning

confidence: 98%

“…After removal of 690 duplicates, a further 2588 articles were excluded after title and abstract screening because they did not meet the prespecified inclusion criteria. The full texts of the remaining 468 studies were evaluated in more detail, and 89 studies were found to meet the eligibility criteria for this systematic review. Among them, 22 studies containing information on clinical factors relevant to recurrence sites were selected for the meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The Cochrane Collaboration tool for assessing risk of bias showed that one study had no domain with a high risk of bias and three studies had one of seven domains with a high risk of bias ( Table S3 , supporting information). The overall risk of bias in non‐randomized studies, according to ROBINS‐I, was moderate in 48 studies and serious in 37 studies ( Table S4 , supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…). Data on RFS were available from 17 studies, and survival after recurrence was reported in nine studies. The weighted median RFS and survival after recurrence were 12·7 (8·0–20·0) and 7·9 (5·0–13·9) months respectively for LR recurrence, 7·7 (5·0–12·0) and 6·5 (range 5·0–8·8) months for liver recurrence, 15·6 (5·2–19·6) and 12·1 (8·8–20·0) months for lung recurrence, and 8·8 (2·0–15·0) and 4·3 (1·7–7·0) months for PeD.…”

Section: Resultsmentioning

confidence: 99%

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Meta-analysis of recurrence pattern after resection for pancreatic cancer

Tanaka

Mihaljevic

Probst

et al. 2019

British Journal of Surgery

148

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Background: Initial recurrence mapping of resected pancreatic ductal adenocarcinoma (PDAC) could help in stratifying patient subpopulations for optimal postoperative follow-up. The aim of this systematic review and meta-analysis was to investigate the initial recurrence patterns of PDAC and to correlate them with clinicopathological factors.Methods: MEDLINE and Web of Science databases were searched systematically for studies reporting first recurrence patterns after PDAC resection. Data were extracted from the studies selected for inclusion. Pooled odds ratios (ORs) and 95 per cent confidence intervals were calculated to determine the clinicopathological factors related to the recurrence sites. The weighted average of median overall survival was calculated.Results: Eighty-nine studies with 17 313 patients undergoing PDAC resection were included. The weighted median rates of initial recurrence were 20⋅8 per cent for locoregional sites, 26⋅5 per cent for liver, 11⋅4 per cent for lung and 13⋅5 per cent for peritoneal dissemination. The weighted median overall survival times were 19⋅8 months for locoregional recurrence, 15⋅0 months for liver recurrence, 30⋅4 months for lung recurrence and 14⋅1 months for peritoneal dissemination. Meta-analysis revealed that R1 (direct) resection (OR 2⋅21, 95 per cent c.i. 1⋅12 to 4⋅35), perineural invasion (OR 5⋅19, 2⋅79 to 9⋅64) and positive peritoneal lavage cytology (OR 5⋅29, 3⋅03 to 9⋅25) were significantly associated with peritoneal dissemination as initial recurrence site. Low grade of tumour differentiation was significantly associated with liver recurrence (OR 4⋅15, 1⋅71 to 10⋅07).

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Meta-analysis of recurrence pattern after resection for pancreatic cancer

Tanaka

Mihaljevic

Probst

et al. 2019

British Journal of Surgery

148

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“…The benefit of adjuvant chemoradiation (CRT) is more controversial and the subject of a recently closed randomized trial (RTOG 0848), for which we are awaiting results. Despite this, several lines of evidence point to the need for better selection of chemoradiation therapy: (1) local-regional recurrence rates for patients who do not receive adjuvant chemoradiation are high; (2) toxicity of chemoradiation is notable; (3) recent evidence suggests that there is a subset of patients with local-regional recurrence predominant disease; and (4) local-regional disease progression can contribute directly to morbidity and mortality [6,7,23,29]. Taken together, this suggests a need to better select patients for aggressive local-regional therapy versus systemic therapy or supportive care alone.…”

Section: Discussionmentioning

confidence: 99%

A microRNA-based signature predicts local-regional failure and overall survival after pancreatic cancer resection

et al. 2020

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Resectable pancreatic adenocarcinoma (PC) is generally managed with surgery followed by chemotherapy, but the role of postoperative chemoradiation (pCRT) is controversial. We sought to identify a microRNA (miRNA) expression profile associated with higher risk for local-regional recurrence (LRR), which might help identify patients that may benefit from pCRT. Total RNA was isolated from viable tumor from 88 patients who underwent PC resection with or without chemotherapy, but did not receive radiation. Digital miRNA expression profiling was performed and risk scores were calculated based on the expression levels of the four most significantly correlated miRNAs, and dichotomized about the median to detect correlations between risk group, LRR and overall survival (OS). Two cohorts from The Cancer Genome Atlas (TCGA) and Seoul National University (SNU) were used for validation. Patients with high-risk scores had significantly worse LRR (p = 0.001) and worse OS (p = 0.034). Two-year OS rates for the high-and low-risk groups were 27.7% and 52.2%, respectively. On multivariable analysis, the risk score remained significantly associated with LRR (p = 0.018). When validated on TCGA data, a high-risk score was associated with worse OS on univariate (p = 0.03) and multivariable analysis (p = 0.017). When validated on the SNU cohort, a high-risk score was likewise associated with worse OS (p = 0.042). We have developed a 4-miRNA molecular signature that is associated with risk of LRR and OS after PC resection and validated on two separate cohorts. This signature has the potential to select patients most likely to benefit from pCRT, and should be tested further.

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Recurrence After Resection of Pancreatic Ductal Adenocarcinoma

2020

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geons wish they would have done something differently in the past. The most common (762 of 1233 [61.8%]) wish was to have achieved a healthier work-life balance, even if that required joining a different practice environment, pursuing a different surgical specialty, or choosing a nonmedical career.These findings seem to contradict the generally held perception that older generations of surgeons placed less emphasis on their personal and family life than the newer surgeons. 4-6 A possible explanation for this contradiction could be that, despite their desire for a healthier work-life balance, earlier generations of surgeons practiced in an era when workplace requirements, professional regulations, and cultural norms were not conducive to a constructive debate on work-life balance. With their more experienced life and work perspective, retired surgeons have a great potential for mentoring younger surgeons 3 to achieve a rewarding career and avoid future regrets. Conclusions |By learning what retired surgeons would advise their younger selves, this survey brings awareness to potentially modifiable factors that could make the life and career of a surgeon healthier, more fulfilling, and without regrets.

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Identifying Clinical Factors Which Predict for Early Failure Patterns Following Resection for Pancreatic Adenocarcinoma in Patients Who Received Adjuvant Chemotherapy Without Chemoradiation

Cited by 8 publications

References 32 publications

Meta-analysis of recurrence pattern after resection for pancreatic cancer

Meta-analysis of recurrence pattern after resection for pancreatic cancer

A microRNA-based signature predicts local-regional failure and overall survival after pancreatic cancer resection

Recurrence After Resection of Pancreatic Ductal Adenocarcinoma

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