Isolated pulmonary recurrence after resection of pancreatic cancer: the effect of patient factors and treatment modalities on survival

Abstract

Background: The literature suggests favorable survival for patients with isolated pulmonary recurrence after resection of pancreatic ductal adenocarcinoma (PDAC) as compared to other recurrence patterns. Within this cohort, it remains unclear what factors are associated with improved survival. Methods: Patients who developed pulmonary recurrence after pancreatectomy were selected from a prospective database. Predictors for post-recurrence survival (PRS) were analyzed using a multivariable Cox regression model. Results: Ninety-six patients were included. Median recurrence-free survival (RFS), PRS and overall survival (OS) were 16.3, 18.8 and 39.6 months, respectively. Further systemic treatment and/or metastasectomy (n = 64, 67%) was associated with significantly improved PRS and OS when compared to best supportive care (n = 35, 22%) (26.3 vs. 5.3 and 48.1 vs. 18.4, respectively; both P < 0.001). Patients who were able to undergo metastasectomy (n = 19) achieved a PRS and OS of 35.0 and 68.9 months, respectively. More than 5 pulmonary lesions, symptoms and CA 19-9 100 U/mL at time of recurrence were predictive of decreased PRS. A recurrence-free interval of >16 months and treatment for recurrence were independently associated with improved PRS. Conclusions: Isolated pulmonary recurrence occurs in 13% of patients with recurrent PDAC and is associated with a median OS of 40 months. Aggressive treatment in highly selected patients was correlated with improved survival.

Surgery for synchronous and metachronous single-organ metastasis of pancreatic cancer: a SEER database analysis and systematic literature review

“…Molecular analysis has helped to identify those patients that may benefit from resection of metastasis of colorectal cancer 25 . In the future, molecular subtyping might also help to identify key signaling pathways and potential surrogates to select metastatic pancreatic cancer patients for whom surgical resection might be beneficial [26][27][28] . Since there are no prospective, randomized trials, solid evidence of criteria for patient selection is lacking.…”

Surgery for Recurrent Pancreatic Cancer: Is It Effective?

“…After screening titles and abstracts, 243 full-text articles were assessed for eligibility and 14 studies [1,6,15,16,17,18,19,20,21,22,23,24,25,26] were ultimately included in our critical appraisal (Figure 1). Nine papers dealt with isolated local recurrences (ILR) [1,16,17,18,19,20,21,22,26], two with the surgical treatment of lung metastases [24,25], and three reported the surgical results of both local and distant pancreatic recurrences [6,15,23]. Indications for re-resection/exploration in these patients were a strong probability of a potentially-resectable recurrence and no signs of further disseminated disease in patients in acceptable general conditions (ASA, American Society of Anesthesiologists, 1–3).…”

“…However, the real proportion of resected patient over the total number of recurrence, is considerably less. A subgroup analysis of the case series presenting both, the number of patients recurrent and resected [1,6,15,16,17,19,20,21,22,23,25], show a proportion of resection/recurrence rate of 6.4% (82 out of 1281 patients) (Table 1).…”

“…In these patients the median overall survival (OS) ranged between 10.8 and 30 months after primary pancreatectomy, and between 6 and 11 months after their recurrent PDAC was diagnosed. In six studies [17,20,22,23,25,26], the median survival was significantly longer for patients who underwent surgery for a recurrence than for unresected patients.…”

“…Isolated lung metastases from pancreatic cancer have also been associated with a good outcome after surgical resection. Two different studies [24,25] on the surgical treatment of solitary lung metastases showed a survival benefit compared with solitary distant recurrences at other sites. The indolent nature of lung metastases from PDAC has been suggested by other authors too [38,39], who found that patients with recurrences limited to the lung had a longer median survival after their disease recurred than those whose disease relapsed at other sites.…”