Abstract
We analyzed the pattern of failure and clinicopathologic factors influencing the disease-free survival of 78 patients who died after macroscopic curative resection for pancreatic cancer. Local recurrence was a component of failure in 56 patients (71.8%) and hepatic recurrence in 48 (61.5%), both accounting for 97% of the total recurrence rate. About 95% of recurrences occurred by 24 months after operation. Median disease-free survival time was 8 months, and cumulative 1-, 3-, and 5-year actuarial disease-free survival rates were 66%, 7%, and 3%, respectively. Multivariate analysis showed that tumor grade (p = 0.04), microscopic radicality of resection (p = 0.04), lymph node status (p = 0.01), and size of the tumor (p = 0.005) were independent predictors of disease-free survival. Patterns of failure and disease-free survival were not statistically influenced by the type of surgical procedure performed. Median survival time from the detection of recurrence until death was 7 months for local recurrence versus 3 months for hepatic or local plus hepatic recurrence (p < 0.05). From our experience and the data collected from the literature, it appears that surgery alone is an inadequate treatment for cure in patients with pancreatic carcinoma. Effective adjuvant therapies are needed to improve locoregional control of pancreatic cancer after surgical resection.
Résumé
Les échecs thérapeutiques et les facteurs clinico-pathologiques jouant un rôle sur la survie sans maladic ont étéanalysés chez 78 patients décédés après une résection pancréatique à visée macroscopiquement curatrice. La récidive locale a été constatée chez 56 patients (71.8%), la récidive sous forme de localisation hépatique chez 48 (61.5%), l’ensemble des deux représentant 97% des récidives globales. Quatre-vingt quinze pour-cent des récidives se sont produites moins de 24 mois après l’intervention. La durée médiane de survie sans maladie a été de 8 mois et les survies cumulatives actuarielles à 1, 3 et à 5 ans ont été respectivement de 66%, 7% et 3%. L’analyse multifactorielle a montré que le stade tumoral (p = 0.04), la radicalité de la résection (p = 0.04), l’état ganglionnaire (p = 0.01) et la taille de la tumeur (p = 0.005) étaient des facteurs indépendants de prédiction de survie sans maladie. Ni les échecs ni la survie n’ont été statistiquement influencés par le type de chirurgie effectuée. La durée médiane entre la détection de la récidive et le décès a été de 7 mois pour la récidive locale contre trois mois pour la récidive hépatique ou combinée, hépatique et locale (p < 0.05). A partir de notre expérience et l’information recucillie dans la littérature, il apparaît que la chirurgie scule ne suffit pas pour traiter le cancer pancréatique. On a besoin de thérapeutiques adjuvantes pour améliorer le contrôle locorégional du cancer du pancréas après résection.
Resumen
Analizamos el patrón de falla y los factores clínico-patológicos que tienen influencia sobre la sobrevida libre de enfermedad de 78 pacientes que murieron luego de resectión macroscópicamente curativa de cáncer pancreático. La recurrencia local fue el componente de falla en 56 pacientes (71.8%), la recurrencia hepática en 48 (61.5%), con ambos factores representando el 97% de la tasa total de recurrencia. Noventa y cinco porciento de las recurrencias ocurrieron en los primeros 24 meses luego de la operación. El intervalo libre de enfermedad promedio fue de 8 meses y las tasas actuariales de sobrevida libre de enfermedad acumulativas a 1, 3 y 5 años fueron 66%, 7% y 3% respectivamente. El análisis multivariado demostró que el grado tumoral (P = 0.04), el estado de los ganglios linfáticos (P = 0.01) y el tamaño del tumor (P = 0.005) son predictores independientes de la sobrevida libre de enfermedad. Los patrones de falla y de sobrevida libre de enfermedad no aparecieron estadísticamente afectados por el tipo de cirugía realizada. El tiempo medio de sobrevida a partir de la detección de la recurrencia hasta la muerte fue de 7 meses para la recurrencia local versus 3 meses para la recurrencia hepática o la recurrencia local más hepática (P < 0.05). Según nuestra experiencia y los datos recolectados de la literatura, parece que la cirugía sola es un tratamiento inadecuado para la curación de pacientes con carcinoma pancreático. Se requieren terapias coadyuvantes eficaces para mejorar el control local-regional del cáncer pancreático luego de la resección quirúrgica.
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Sperti, C., Pasquali, C., Piccoli, A. et al. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J. Surg. 21, 195–200 (1997). https://doi.org/10.1007/s002689900215
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DOI: https://doi.org/10.1007/s002689900215