Patterns of recurrence after curative-intent surgery for pancreas cancer reinforce the importance of locoregional control and adjuvant chemotherapy.

Munir, R.; Soreide, K.; Ravindran, R.; Powell, J. J.; Harrison, E.; Adair, A.; Wigmore, S.; Parks, R.; Garden, O. J.; Kirkpatrick, L.; Wall, L. R.; Christie, A.; Penman, I.; McAvoy, N.; Save, V.; Stockman, A.; Worrral, D.; Ireland, H.; Weir, G.; Masson, N.; Hay, C.; Gordon-Smith, J.; Mole, D. J.

doi:10.1101/270884

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bioRxiv · 10.1101/270884

Patterns of recurrence after curative-intent surgery for pancreas cancer reinforce the importance of locoregional control and adjuvant chemotherapy.

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Abstract

IntroductionThe pattern of recurrence after surgical excision of pancreas cancer may guide alternative pre-operative strategies to either detect occult disease or need for chemotherapy. This study investigated patterns of recurrence after pancreatic surgery.\n\nMethodsRecurrence patterns were described in a series of resected pancreas cancers over a 2-year period and recurrence risk expressed as odds ratio (OR) with 95% confidence interval (C.I.). Survival was displayed by Kaplan-Meier curves.\n\nResultsOf 107 pancreas resections, 69 (65%) had pancreatic cancer. R0 resection was achieved in 21 of 69 (30.4%). Analysis was based on 66 patients who survived 30 days after surgery with median follow up 21 months. Recurrence developed in 41 (62.1%) patients with median time to first recurrence of 13.3 months (interquartile range 6.9, 20.8 months). Recurrence site was most frequently locoregional (n=28, 42%), followed by liver (n=23, 35%), lymph nodes (n=21, 32%), and lungs (n=13, 19%). In patients with recurrence, 9 of 41 had single site recurrence; the remaining 32 patients had more than one site of recurrence. Locoregional recurrence was associated with R+ resection (53% vs 25% for R+ vs R0, respectively; OR 3.5, 95% C.I. 1.1-11.2; P=0.034). Venous invasion was associated with overall recurrence risk (OR 3.3, 95% C.I. 1.1-9.4; P=0.025). In multivariable analysis, R-stage and adjuvant chemotherapy predicted longer survival.\n\nDiscussionThe predominant locoregional recurrence pattern, multiple sites of recurrence and a high R+ resection rate reflect the difficulty in achieving initial local disease control.

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Munir, R., Soreide, K., Ravindran, R., Powell, J. J., Harrison, E., Adair, A., Wigmore, S., Parks, R., Garden, O. J., Kirkpatrick, L., Wall, L. R., Christie, A., Penman, I., McAvoy, N., Save, V., Stockman, A., Worrral, D., Ireland, H., Weir, G., Masson, N., Hay, C., Gordon-Smith, J., Mole, D. J.. 2018-02-28. Patterns of recurrence after curative-intent surgery for pancreas cancer reinforce the importance of locoregional control and adjuvant chemotherapy.. https://doi.org/10.1101/270884

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