Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma
Abstract
Objective: To describe accurately the pattern, timing, and predictors of disease recurrence after a potentially curative resection for pancreatic ductal adenocarcinoma (PDAC). Summary Background Data: After surgery for PDAC, most patients will develop disease recurrence. Understanding the patterns and timing of disease failure can help guide improvements in therapy. Methods: Patients who underwent pancreatectomy for PDAC at the Johns Hopkins Hospital between 2000 and 2010 were included. Exclusion criteria were incomplete follow-up records, follow-up <24 months, and neoadjuvant therapy. The first recurrence site was recorded and recurrence-free survival (RFS) was estimated using Kaplan–Meier curves. Predictive factors for specific recurrence patterns were assessed by univariate and multivariate analyses using Cox-proportional hazard regression models. Results: From the identified cohort of 1103 patients, 692 patients had comprehensive and detailed follow-up data available. At a median follow-up of 25.3 months, 531 (76.7%) of the 692 had recurred after a median RFS of 11.7 months. Most patients recurred at isolated distant sites (n = 307, 57.8%), while isolated local recurrence was seen in 126 patients (23.7%). Liver-only recurrence (n = 134, 25.2%) tended to occur early (median 6.9 mo), while lung-only recurrence (n = 78, 14.7%) occurred later (median 18.6 mo). A positive lymph node ratio >0.2 was a strong predictor for all distant disease recurrence. Patients receiving adjuvant chemotherapy or chemoradiotherapy had fewer recurrences and a longer RFS of 18.0 and 17.2 months, respectively. Conclusions: Specific recurrence locations have different predictive factors and possess distinct RFS curves, supporting the hypothesis that unique biological differences exist among tumors leading to distinct patterns of recurrence.
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Recurrence after resection suggests that patients undergoing resection also harbor micro-metastatic disease.
“suggesting patients undergoing resection also harbor micro-metastatic disease11.”
From Pancreatic cancer: Advances and challenges (2023) · cites this paper as [11]
Nearly three of four patients who undergo surgical resection for PDAC develop recurrence within two years.
“nearly 3 in 4 of patients will develop recurrence within two years”
From Pancreatic cancer: Advances and challenges (2023) · cites this paper as [11]
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- Authors
- Groot, V. P., Rezaee, N., Wu, W., Cameron, J. L., Fishman, E. K., Hruban, R. H., Weiss, M. J., Zheng, L., Wolfgang, C. L., & He, J.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Groot, Vincent P.
- Rezaee, Neda
- Wu, Wenchuan
- Cameron, John L.
- Weiss, Matthew J.
- Wolfgang, Christopher L.
- He, Jin
- ORCID
- Venue
- Annals of Surgery
- Published
- 2018-05
- Volume
- 267
- Issue
- 5
- Pages
- 936-945
- ISSN
- 0003-4932 (ISSN-L)
- 1528-1140
- OpenAlex
- W2601014096
- Cited by
- 757
- References
- 46
- Citations by year
- 2026: 87 · 2025: 127 · 2024: 104 · 2023: 116 · 2022: 100 · 2021: 79 · 2020: 57 · 2019: 43 · 2018: 31 · 2017: 11
- FWCI
- 17.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (T32CA126607)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Surgery › Cholangiocarcinoma and Gallbladder Cancer Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › MRI in cancer diagnosis
- Keywords
- pancreatic ductal adenocarcinoma, pancreatic resection, recurrence, recurrence patterns, time to recurrence, recurrence-free survival, liver recurrence, lung recurrence, local recurrence, lymph node ratio, adjuvant chemotherapy, chemoradiotherapy, predictors of recurrence
- MeSH terms
- Aged, Female, Follow-Up Studies, Humans, Male, Maryland, Neoplasm Recurrence, Local, Pancreatectomy, Pancreatic Neoplasms, Postoperative Period, Prognosis, Retrospective Studies, Time Factors, Incidence, Survival Rate, Carcinoma, Pancreatic Ductal
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