Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands: A Nationwide Analysis

Dutch Pancreatic Cancer Group, Lois A Daamen, Vincent P Groot, Marc G Besselink, Koop Bosscha, Olivier R Busch, Geert A Cirkel, Ronald M van Dam, Sebastiaan Festen, Bas Groot Koerkamp, Nadia Haj Mohammad, Erwin van der Harst, Ignace H J T de Hingh, Martijn P W Intven, Geert Kazemier, Maartje Los, Gert J Meijer, Vincent E de Meijer, Vincent B Nieuwenhuijs, Bobby K PrangerMihaela G Raicu, Jennifer M J Schreinemakers, Martijn W J Stommel, Robert C Verdonk, Helena M Verkooijen, Izaak Quintus Molenaar, Hjalmar C van Santvoort*

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

Samenvatting

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.

Originele taal-2English
Aantal pagina's7
TijdschriftAnnals of Surgery
DOI's
StatusE-pub ahead of print - 8-jul-2020

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