Ann Hepatobiliary Pancreat Surg.  2024 May;28(2):248-261. 10.14701/ahbps.23-149.

Prognostication for recurrence patterns after curative resection for pancreatic ductal adenocarcinoma

• Ang A
• Michaelides A
• Chelala C
• Ullah D
• Kocher HM
• Barts Pancreas Tissue Bank

• KMID: 2555935
• DOI: http://doi.org/10.14701/ahbps.23-149

Abstract

Backgrounds/Aims
This study aimed to investigate patterns and factors affecting recurrence after curative resection for pancreatic ductal adenocarcinoma (PDAC).
Methods
Consecutive patients who underwent curative resection for PDAC (2011-21) and consented to data and tissue collection (Barts Pancreas Tissue Bank) were followed up until May 2023. Clinico-pathological variables were analysed using Cox proportional hazards model.
Results
Of 91 people (42 males [46%]; median age, 71 years [range, 43–86 years]) with a median follow-up of 51 months (95% confidence intervals [CIs], 40–61 months), the recurrence rate was 72.5% (n = 66; 12 loco-regional alone, 11 liver alone, 5 lung alone, 3 peritoneal alone, 29 simultaneous loco-regional and distant metastases, and 6 multi-focal distant metastases at first recurrence diagnosis). The median time to recurrence was 8.5 months (95% CI, 6.6–10.5 months). Median survival after recurrence was 5.8 months (95% CI, 4.2–7.3 months). Stratification by recurrence location revealed significant differences in time to recurrence between loco-regional only recurrence (median, 13.6 months; 95% CI, 11.7–15.5 months) and simultaneous loco-regional with distant recurrence (median, 7.5 months; 95% CI, 4.6–10.4 months; p = 0.02, pairwise log-rank test). Significant predictors for recurrence were systemic inflammation index (SII) ≥ 500 (hazard ratio [HR], 4.5; 95% CI, 1.4–14.3), lymph node ratio ≥ 0.33 (HR, 2.8; 95% CI, 1.4–5.8), and adjuvant chemotherapy (HR, 0.4; 95% CI, 0.2–0.7).
Conclusions
Timing to loco-regional only recurrence was significantly longer than simultaneous loco-regional with distant recurrence. Significant predictors for recurrence were SII, lymph node ration, and adjuvant chemotherapy.

Keyword

Overall survival; Disease free survival; Multivariate analysis; Lymph node ratio; Systemic inflammation index

Figure

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  Fig. 1 Flow chart of patient enrolment in this study. BPTB, Barts Pancreas Tissue Bank; PDAC, pancreatic ductal adenocarcinoma.

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  Fig. 2 Kaplan–Meier OS curve for recurrence vs. no recurrence. OS, overall survival.

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  Fig. 3 Scatter plot of disease-free survival stratified by location specific recurrence.

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  Fig. 4 Kaplan–Meier survival curve for DFS stratified by recurrence location. DFS, disease-free survival.

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  Fig. 5 Kaplan–Meier DFS curve for SII < 500 vs. ≥ 500. SII, systemic inflammation index; DFS, disease-free survival.

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  Fig. 6 Kaplan–Meier DFS curve for LNR < 0.33 vs. ≥ 0.33. LNR, lymph node ratio; DFS, disease-free survival.

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  Fig. 7 Kaplan–Meier DFS curve for adjuvant chemotherapy vs. no adjuvant chemotherapy. DFS, disease-free survival.

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  Fig. 8 Kaplan–Meier survival curve for OS stratified by recurrence location. OS, overall survival.

Reference

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