Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Prognostication for recurrence patterns after curative resection for pancreatic ductal adenocarcinoma

  • Andrew Ang (The Royal London Hospital, Barts Health NHS Trust) ;
  • Athena Michaelides (The Royal London Hospital, Barts Health NHS Trust) ;
  • Claude Chelala (Barts Cancer Institute, Queen Mary University of London, John Vane Science Centre) ;
  • Dayem Ullah (Barts Cancer Institute, Queen Mary University of London, John Vane Science Centre) ;
  • Hemant M. Kocher (The Royal London Hospital, Barts Health NHS Trust)
  • Received : 2023.11.15
  • Accepted : 2024.02.10
  • Published : 2024.05.31
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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.

Keywords

Acknowledgement

Barts Pancreas Tissue Bank is funded by Pancreatic Cancer Research Fund. The Operations Group is chaired by Prof Hemant Kocher/Prof Claude Chelala and Tissue Access Committee by Professor Richard Grose. Vickna Balarajah, Abhirup Banerjee, Mafalda CostaNeves, Konstantinos Stasinos, Mohamed Zardab, Andreas Konstantinou helped with clinical verification of data collection. Past members helping in running of Barts Pancreas Tissue Bank include, Archana Ambily, Thomas Dowe, Ajith Vajrala, and Ope Banwo. We are grateful to consultant surgeons at Barts: Satyajit Bhattacharya, Robert Hutchins, Ajit Abraham, Vincent Yip, Deepak Hariharan, Omar Mowanah for access to their patients. We are grateful to Dr Joanne Chin-Aleong, Consultant Pathologist and Dr David Propper/Dr Sarah Slater, Consultant Oncologist for their valuable advice.

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