TY - JOUR
T1 - Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands A Nationwide Analysis
AU - Dutch Pancreatic Canc Grp
AU - Daamen, Lois A.
AU - Groot, Vincent P.
AU - Besselink, Marc G.
AU - Bosscha, Koop
AU - Busch, Olivier R.
AU - Cirkel, Geert A.
AU - van Dam, Ronald M.
AU - Festen, Sebastiaan
AU - Groot Koerkamp, Bas
AU - Haj Mohammad, Nadia
AU - van der Harst, Erwin
AU - de Hingh, Ignace H. J. T.
AU - Intven, Martijn P. W.
AU - Kazemier, Geert
AU - Los, Maartje
AU - Meijer, Gert J.
AU - de Meijer, Vincent E.
AU - Nieuwenhuijs, Vincent B.
AU - Pranger, Bobby K.
AU - Raicu, Mihaela G.
AU - Schreinemakers, Jennifer M. J.
AU - Stommel, Martijn W. J.
AU - Verdonk, Robert C.
AU - Verkooijen, Helena M.
AU - Molenaar, Izaak Quintus
AU - van Santvoort, Hjalmar C.
PY - 2022/4
Y1 - 2022/4
N2 - OBJECTIVE: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival.SUMMARY OF BACKGROUND DATA: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence.METHODS: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014-2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence.RESULTS: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001].CONCLUSIONS: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.
AB - OBJECTIVE: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival.SUMMARY OF BACKGROUND DATA: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence.METHODS: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014-2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence.RESULTS: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001].CONCLUSIONS: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.
KW - disease recurrence
KW - follow-up
KW - pancreatic ductal adenocarcinoma
KW - PDAC
KW - surveillance
KW - ISOLATED LOCAL RECURRENCE
KW - DUCTAL ADENOCARCINOMA
KW - FOLLOW-UP
KW - RESECTION
KW - SURVEILLANCE
KW - ASSOCIATION
KW - GUIDELINES
KW - GEMCITABINE
KW - FOLFIRINOX
KW - THERAPY
U2 - 10.1097/SLA.0000000000004093
DO - 10.1097/SLA.0000000000004093
M3 - Article
C2 - 32773631
SN - 0003-4932
VL - 275
SP - 769
EP - 775
JO - Annals of Surgery
JF - Annals of Surgery
IS - 4
ER -