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Daamen, Lois A; Groot, Vincent P; Besselink, Marc G; Bosscha, Koop; Busch, Olivier R; Cirkel, Geert A; van Dam, Ronald M; Festen, Sebastiaan; Groot Koerkamp, Bas; Haj Mohammad, Nadia; van der Harst, Erwin; de Hingh, Ignace H. J T; Intven, Martijn P W; Kazemier, Geert; Los, Maartje; Meijer, Gert J; de Meijer, Vincent E; Nieuwenhuijs, Vincent B; Pranger, Bobby K; Raicu, Mihaela G; Schreinemakers, Jennifer M J; Stommel, Martijn W J; Verdonk, Robert C; Verkooijen, Helena M; Molenaar, Izaak Quintus; van Santvoort, Hjalmar C
Annals of surgery, 04/2022, Letnik: 275, Številka: 4Journal Article
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.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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Vir: Osebne bibliografije
in: SICRIS
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