Loco-recurrence after resection for ductal adenocarcinoma of the pancreas: Predictors and implications for adjuvant chemoradiotherapy

Yaojun Zhang, Adam E. Frampton, Charis Kyriakides, Jan J. Bong, Nagy Habib, Raida Ahmad, Long R. Jiao

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose Loco (regional)-recurrence rate after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains high, and the efficiency of adjuvant chemoradiotherapy is still debated. We aimed to assess predictors of loco-recurrence in order to tailor the indications for adjuvant chemoradiotherapy. Methods Patients who underwent PD for PDAC between January 2001 and December 2010 were retrieved from a prospective database. Tumor recurrence was categorized as either loco-recurrence or distant recurrence. Clinicopathological characteristics and survivals were compared between patients with different recurrence patterns. The predictors for loco-recurrence were assessed. Results Seventy-nine patients were included. Loco-recurrence alone was identified in 22 patients (27.8%), distant recurrence alone in 33 (41.8%), both loco- and distant recurrences in 17 (21.5%) and no recurrence in 7 (8.9%). Median survival after recurrence (SAR) was significantly better in patients with loco-recurrence alone than in those with distant recurrence alone (10.4 vs. 5.0 months, P = 0.002) or in those with both loco- and distant recurrences (10.4 vs. 5.8 months, P = 0.044); the survival for patients with distant recurrence alone and those with both patterns was identical. Patients with early recurrence had a significantly poorer SAR than those with late recurrence (median, 5.5 vs. 9.0 months, P = 0.001). Logistic regression analysis revealed that positive resection margin (P = 0.001, HR = 14.532; 95% CI 7.399-38.466), early T stage (P = 0.018, HR = 0.014; 95% CI 0.000-0.475) and large tumor size (P = 0.030, HR = 4.345; 95% CI 1.152- 16.391) were the determinant factors directly related to loco-recurrence alone. Conclusions Patients with PDAC loco-recurrence alone had a significantly better SAR than those with distant recurrence. Adjuvant chemoradiotherapy should be considered to reduce loco-recurrence further and improve long-term survival.

Original languageEnglish
Pages (from-to)1063-1071
Number of pages9
JournalJournal of Cancer Research and Clinical Oncology
Volume138
Issue number6
DOIs
Publication statusPublished - Jun 2012
Externally publishedYes

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Adjuvant Chemoradiotherapy
Pancreas
Adenocarcinoma
Recurrence
Survival
Pancreaticoduodenectomy

Keywords

  • Pancreatic ductal adenocarcinoma
  • Pancreaticoduodenectomy
  • Predictors
  • Recurrence
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Loco-recurrence after resection for ductal adenocarcinoma of the pancreas : Predictors and implications for adjuvant chemoradiotherapy. / Zhang, Yaojun; Frampton, Adam E.; Kyriakides, Charis; Bong, Jan J.; Habib, Nagy; Ahmad, Raida; Jiao, Long R.

In: Journal of Cancer Research and Clinical Oncology, Vol. 138, No. 6, 06.2012, p. 1063-1071.

Research output: Contribution to journalArticle

Zhang, Yaojun ; Frampton, Adam E. ; Kyriakides, Charis ; Bong, Jan J. ; Habib, Nagy ; Ahmad, Raida ; Jiao, Long R. / Loco-recurrence after resection for ductal adenocarcinoma of the pancreas : Predictors and implications for adjuvant chemoradiotherapy. In: Journal of Cancer Research and Clinical Oncology. 2012 ; Vol. 138, No. 6. pp. 1063-1071.
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abstract = "Purpose Loco (regional)-recurrence rate after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains high, and the efficiency of adjuvant chemoradiotherapy is still debated. We aimed to assess predictors of loco-recurrence in order to tailor the indications for adjuvant chemoradiotherapy. Methods Patients who underwent PD for PDAC between January 2001 and December 2010 were retrieved from a prospective database. Tumor recurrence was categorized as either loco-recurrence or distant recurrence. Clinicopathological characteristics and survivals were compared between patients with different recurrence patterns. The predictors for loco-recurrence were assessed. Results Seventy-nine patients were included. Loco-recurrence alone was identified in 22 patients (27.8{\%}), distant recurrence alone in 33 (41.8{\%}), both loco- and distant recurrences in 17 (21.5{\%}) and no recurrence in 7 (8.9{\%}). Median survival after recurrence (SAR) was significantly better in patients with loco-recurrence alone than in those with distant recurrence alone (10.4 vs. 5.0 months, P = 0.002) or in those with both loco- and distant recurrences (10.4 vs. 5.8 months, P = 0.044); the survival for patients with distant recurrence alone and those with both patterns was identical. Patients with early recurrence had a significantly poorer SAR than those with late recurrence (median, 5.5 vs. 9.0 months, P = 0.001). Logistic regression analysis revealed that positive resection margin (P = 0.001, HR = 14.532; 95{\%} CI 7.399-38.466), early T stage (P = 0.018, HR = 0.014; 95{\%} CI 0.000-0.475) and large tumor size (P = 0.030, HR = 4.345; 95{\%} CI 1.152- 16.391) were the determinant factors directly related to loco-recurrence alone. Conclusions Patients with PDAC loco-recurrence alone had a significantly better SAR than those with distant recurrence. Adjuvant chemoradiotherapy should be considered to reduce loco-recurrence further and improve long-term survival.",
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T1 - Loco-recurrence after resection for ductal adenocarcinoma of the pancreas

T2 - Predictors and implications for adjuvant chemoradiotherapy

AU - Zhang, Yaojun

AU - Frampton, Adam E.

AU - Kyriakides, Charis

AU - Bong, Jan J.

AU - Habib, Nagy

AU - Ahmad, Raida

AU - Jiao, Long R.

PY - 2012/6

Y1 - 2012/6

N2 - Purpose Loco (regional)-recurrence rate after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains high, and the efficiency of adjuvant chemoradiotherapy is still debated. We aimed to assess predictors of loco-recurrence in order to tailor the indications for adjuvant chemoradiotherapy. Methods Patients who underwent PD for PDAC between January 2001 and December 2010 were retrieved from a prospective database. Tumor recurrence was categorized as either loco-recurrence or distant recurrence. Clinicopathological characteristics and survivals were compared between patients with different recurrence patterns. The predictors for loco-recurrence were assessed. Results Seventy-nine patients were included. Loco-recurrence alone was identified in 22 patients (27.8%), distant recurrence alone in 33 (41.8%), both loco- and distant recurrences in 17 (21.5%) and no recurrence in 7 (8.9%). Median survival after recurrence (SAR) was significantly better in patients with loco-recurrence alone than in those with distant recurrence alone (10.4 vs. 5.0 months, P = 0.002) or in those with both loco- and distant recurrences (10.4 vs. 5.8 months, P = 0.044); the survival for patients with distant recurrence alone and those with both patterns was identical. Patients with early recurrence had a significantly poorer SAR than those with late recurrence (median, 5.5 vs. 9.0 months, P = 0.001). Logistic regression analysis revealed that positive resection margin (P = 0.001, HR = 14.532; 95% CI 7.399-38.466), early T stage (P = 0.018, HR = 0.014; 95% CI 0.000-0.475) and large tumor size (P = 0.030, HR = 4.345; 95% CI 1.152- 16.391) were the determinant factors directly related to loco-recurrence alone. Conclusions Patients with PDAC loco-recurrence alone had a significantly better SAR than those with distant recurrence. Adjuvant chemoradiotherapy should be considered to reduce loco-recurrence further and improve long-term survival.

AB - Purpose Loco (regional)-recurrence rate after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) remains high, and the efficiency of adjuvant chemoradiotherapy is still debated. We aimed to assess predictors of loco-recurrence in order to tailor the indications for adjuvant chemoradiotherapy. Methods Patients who underwent PD for PDAC between January 2001 and December 2010 were retrieved from a prospective database. Tumor recurrence was categorized as either loco-recurrence or distant recurrence. Clinicopathological characteristics and survivals were compared between patients with different recurrence patterns. The predictors for loco-recurrence were assessed. Results Seventy-nine patients were included. Loco-recurrence alone was identified in 22 patients (27.8%), distant recurrence alone in 33 (41.8%), both loco- and distant recurrences in 17 (21.5%) and no recurrence in 7 (8.9%). Median survival after recurrence (SAR) was significantly better in patients with loco-recurrence alone than in those with distant recurrence alone (10.4 vs. 5.0 months, P = 0.002) or in those with both loco- and distant recurrences (10.4 vs. 5.8 months, P = 0.044); the survival for patients with distant recurrence alone and those with both patterns was identical. Patients with early recurrence had a significantly poorer SAR than those with late recurrence (median, 5.5 vs. 9.0 months, P = 0.001). Logistic regression analysis revealed that positive resection margin (P = 0.001, HR = 14.532; 95% CI 7.399-38.466), early T stage (P = 0.018, HR = 0.014; 95% CI 0.000-0.475) and large tumor size (P = 0.030, HR = 4.345; 95% CI 1.152- 16.391) were the determinant factors directly related to loco-recurrence alone. Conclusions Patients with PDAC loco-recurrence alone had a significantly better SAR than those with distant recurrence. Adjuvant chemoradiotherapy should be considered to reduce loco-recurrence further and improve long-term survival.

KW - Pancreatic ductal adenocarcinoma

KW - Pancreaticoduodenectomy

KW - Predictors

KW - Recurrence

KW - Survival

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