Predictors of distant metastasis on exploration in patients with potentially resectable pancreatic cancer

Abstract

BackgroundPatients with potentially resectable pancreatic ductal adenocarcinoma (PDAC) are frequently found to be unresectable on exploration due to small distant metastasis. This study was to investigate predictors of small distant metastasis in patients with potentially resectable PDAC.MethodsPatients who underwent surgical exploration for potentially resectable PDAC from 2013 to 2014 were reviewed retrospectively and divided into two groups according to whether distant metastases were encountered on exploration. Then, univariate and multivariate logistic regression analyses were used to identify predictors of distant metastasis. A scoring system to predict distant metastasis of PDAC on exploration was constructed based on the regression coefficient of a multivariate logistic regression model.ResultsA total of 235 patients were included in this study. Mean age of the study population was 61.7 ± 10.4 years old. Upon exploration, distant metastases were found intraoperatively in 62 (26.4%) patients, while the remaining 173 were free of distant metastases. Multivariate logistic regression analysis identified that age ≤ 62 years old (p < 0.001), male sex (p = 0.011), tumor size ≥4.0 cm (p < 0.001), alanine aminotransferase level (ALT) < 125 U/L (p < 0.001), and carbohydrate antigen (CA19–9) level ≥ 385 U/mL (p < 0.001) were independent risk factors for occult distant metastasis of PDAC. A preoperative scoring system (0–8 points) for distant metastasis on exploration was constructed using these five factors. The receiver operating characteristic curves showed that the area under the curve of this score was 0.85. A score of 6 points was suggested to be the optimal cut-off value, and the sensitivity and specificity were 85% and 69%, respectively.ConclusionsDistant metastasis is still frequently encountered on exploration for patients with potentially resectable PDAC. Younger age, male sex, larger tumor size, low ALT level and high CA19–9 level are independent predictors of unexpected distant metastasis on exploration.

Performance of Multiparametric Functional Imaging and Texture Analysis in Predicting Synchronous Metastatic Disease in Pancreatic Ductal Adenocarcinoma Patients by Hybrid PET/MR: Initial Experience

“…Regarding the tumor size and location, our results were consistent with previous studies (2,3,22,23). The larger the tumor, the more likely it is to have distant metastasis.…”

“…(I-J) Follow up PET/MR 112 days after operation showed the operated region with hyper-intensity in T2 weighted image with fat saturation (J) and without abnormal FDG uptake on PET image (I). (2,22). In a cohort of 1,423 patients with PDAC who underwent pancreatectomies, the occurrence of occult metastatic disease in PDAC accounted for 8% of cases, and multivariable analysis defined four independent predictors for occult metastatic disease (3).…”

“…It often presents at a late stage, and exhibits a 5-year overall survival rate of <8% (1). Distant metastasis is still frequently encountered in the operation of patients with potentially resectable PDAC (2,3). Currently surgical resection is the only curative treatment for PADC.…”

Comparable prevalence of distant metastasis and survival of different primary site for LN + pancreatic tumor

“…Tumor size was an independent risk factor for the occurrence of distant metastasis in pancreatic cancer, and the size of less than 5 cm was higher rate of distant metastasis compared with other size [4]. Previous study also has reported that the younger age, sex, larger size, low ALT and high CA19-9 are thought to be associated with distant metastasis [5]. Unluckily, so far very few studies have explored the risk factors of distant metastasis for LN + pancreatic tumors.…”

Histone demethylase JMJD3 disrupts spectrin-dependent cytoskeleton in Pancreatic Ductal Adenocarcinoma cells by regulating H exokinase domain containing 1 expression

“…Most PDAC patients are diagnosed with metastatic disease, and majority of patients will develop metastatic disease even after the localized lesions are resected [27,28]. Therefore, the development of more effective strategies to combat PDAC metastasis is of paramount importance.…”