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Post-Whipple imaging in patients with pancreatic ductal adenocarcinoma: association with overall survival: a multivariate analysis

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Abstract

Purpose

To compare the survival outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) who had regular imaging surveillance with those who had clinical follow-up after Whipple.

Method

We identified 229 patients, who underwent Whipple for resection of PDAC from 2005 to 2011, and had regular postoperative clinical follow-up at our hospital. Patients were retrospectively selected for two follow-up groups: imaging surveillance (IS) defined as routine imaging at scheduled intervals, vs. clinical (C) defined as imaging triggered by either change in clinical status or change in CA19-9. Follow-up was obtained through the hospital and Cancer Data Registry records. Survival was calculated from the date of surgery to death or last follow-up, with data censored as of March 13, 2013. Kaplan–Meier survival curves were compared using the log-rank test, and Cox regression models were used for multivariate analysis.

Results

Patients were followed for a mean period of 24.35 ± 2.56 months. IS-group underwent significantly more imaging (4.41 vs. 2.08 scans/year). The most frequent imaging was CT of chest and abdomen at 3–4 month interval. Univariate associations with overall survival were detected with post-Whipple ECOG status, T-stage, N-stage, tumor grade, surgical margin, recurrence, and IS. In multivariate analysis, grade, ECOG status, and recurrence were independent predictors of survival. Also, our predictor of interest, IS, was highly associated with longer survival in multivariate modeling (median overall survival, 30.4±3.85 (IS-group) vs. 17.1 ± 2.42 (C-groups) month, log-rank p = 0.002).

Conclusion

Routine imaging surveillance was associated with prolonged overall survival post-Whipple in a multivariate model. This is a hypothesis-generating finding that should be studied prospectively and could ultimately impact surveillance guidelines.

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References

  1. Cancer Facts and Figures (2016) acspc-047079.pdf. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed 2 Dec 2016

  2. Ferrone CR, Brennan MF, Gonen M, et al. (2008) Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg Off J Soc Surg Aliment Tract 12:701–706

    Article  Google Scholar 

  3. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300

    Article  PubMed  Google Scholar 

  4. Hoem D, Viste A (2012) Improving survival following surgery for pancreatic ductal adenocarcinoma–a ten-year experience. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 38:245–251

    CAS  Google Scholar 

  5. Ferrone CR, Pieretti-Vanmarcke R, Bloom JP, et al. (2012) Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery 152:S43–S49

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sener SF, Fremgen A, Menck HR, Winchester DP (1999) Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985-1995, using the National Cancer Database. J Am Coll Surg 189:1–7

    Article  CAS  PubMed  Google Scholar 

  7. Oettle H, Post S, Neuhaus P, et al. (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297:267–277

    Article  CAS  PubMed  Google Scholar 

  8. Lim JE, Chien MW, Earle CC (2003) Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 237:74–85

    Article  PubMed  PubMed Central  Google Scholar 

  9. Riediger H, Keck T, Wellner U, et al. (2009) The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg Off J Soc Surg Aliment Tract 13:1337–1344

    Article  Google Scholar 

  10. Van den Broeck A, Sergeant G, Ectors N, et al. (2009) Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 35:600–604

    Google Scholar 

  11. Kleeff J, Reiser C, Hinz U, et al. (2007) Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg 245:566–572

    Article  PubMed  PubMed Central  Google Scholar 

  12. Witkowski ER, Smith JK, Ragulin-Coyne E, et al. (2012) Is it worth looking? Abdominal imaging after pancreatic cancer resection: a national study. J Gastrointest Surg Off J Soc Surg Aliment Tract 16:121–128

    Article  Google Scholar 

  13. Sheffield KM, Crowell KT, Lin Y-L, et al. (2012) Surveillance of pancreatic cancer patients after surgical resection. Ann Surg Oncol 19:1670–1677

    Article  PubMed  Google Scholar 

  14. Castellanos JA, Merchant NB (2014) Intensity of follow-up after pancreatic cancer resection. Ann Surg Oncol 21:747–751

    Article  PubMed  Google Scholar 

  15. Nordby T, Hugenschmidt H, Fagerland MW, et al. (2013) Follow-up after curative surgery for pancreatic ductal adenocarcinoma: asymptomatic recurrence is associated with improved survival. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 39:559–566

    CAS  Google Scholar 

  16. Heye T, Zausig N, Klauss M, et al. (2011) CT diagnosis of recurrence after pancreatic cancer: is there a pattern? World J Gastroenterol 17:1126–1134

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vincent A, Herman J, Schulick R, Hruban RH, Goggins M (2011) Pancreatic cancer. Lancet Lond Engl 378:607–620

    Article  Google Scholar 

  18. Liao W-C, Chien K-L, Lin Y-L, et al. (2013) Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol 14:1095–1103

    Article  PubMed  Google Scholar 

  19. Han S-S, Jang J-Y, Kim S-W, et al. (2006) Analysis of long-term survivors after surgical resection for pancreatic cancer. Pancreas 32:271–275

    Article  PubMed  Google Scholar 

  20. Rau BM, Moritz K, Schuschan S, et al. (2012) R1 resection in pancreatic cancer has significant impact on long-term outcome in standardized pathology modified for routine use. Surgery 152:S103–S111

    Article  PubMed  Google Scholar 

  21. Konstantinidis IT, Warshaw AL, Allen JN, et al. (2013) Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann Surg 257:731–736

    Article  PubMed  Google Scholar 

  22. Laurence JM, Tran PD, Morarji K, et al. (2011) A systematic review and meta-analysis of survival and surgical outcomes following neoadjuvant chemoradiotherapy for pancreatic cancer. J Gastrointest Surg Off J Soc Surg Aliment Tract 15:2059–2069

    Article  Google Scholar 

  23. Colbert LE, Hall WA, Nickleach D, et al. (2014) Chemoradiation therapy sequencing for resected pancreatic adenocarcinoma in the National Cancer Data Base. Cancer 120:499–506

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA, 02114, USA

    Azadeh Elmi, Sandeep Hedgire, Shaunagh McDermott, Seyed-Mahdi Abtahi & Mukesh Harisinghani

  2. Division of Hematology and Oncology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA

    Janet Murphy

  3. Institute for Technology Assessment, Radiology - Data Group, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Elkan Halpern

  4. General and Gastrointestinal Surgery Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA

    Carlos Fernandez-del Castillo

Authors
  1. Azadeh Elmi
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  2. Janet Murphy
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  3. Sandeep Hedgire
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  4. Shaunagh McDermott
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  5. Seyed-Mahdi Abtahi
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  8. Mukesh Harisinghani
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Correspondence to Sandeep Hedgire.

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No funding was received for this study.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Statement of informed consent was not applicable since the manuscript does not contain any patient data.

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Elmi, A., Murphy, J., Hedgire, S. et al. Post-Whipple imaging in patients with pancreatic ductal adenocarcinoma: association with overall survival: a multivariate analysis. Abdom Radiol 42, 2101–2107 (2017). https://doi.org/10.1007/s00261-017-1099-2

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  • DOI: https://doi.org/10.1007/s00261-017-1099-2

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