作者
James Lucocq,Jake Hawkyard,Francis P. Robertson,Beate Haugk,Jenny Lye,Daniel Parkinson,Steve White,O. Mownah,Yoh Zen,Krishna Menon,Takaaki Furukawa,Yosuke Inoue,Yuichi Hirose,Naoki Sasahira,Michael Feretis,Anita Balakrishnan,Piotr Zelga,C Ceresa,Brian R Davidson,Rupaly Pandé,Bobby Dasari,Lulu Tanno,Dimitrios Karavias,Jack Helliwell,A. Young,Quentin Nunes,Tomas Urbonas,Michael Silva,Alex Gordon-Weeks,Jenifer Barrie,Dhanny Gomez,Stijn van Laarhoven,Joseph P. Doyle,Ricky H. Bhogal,Ewen M Harrison,Marcus Roalsø,Debora Ciprani,Somaiah Aroori,Bathiya Ratnayake,Jonathan Koea,Gabriele Capurso,Ruben Bellotti,Stefan Stättner,Tareq Alsaoudi,Neil Bhardwaj,Fraser Jeffery,Saxon Connor,A. F. Cameron,Nigel B. Jamieson,Amy Sheen,Anubhav Mittal,Jas Samra,Anthony J. Gill,Keith Roberts,Kjetil Søreide,Sanjay Pandanaboyana
摘要
Objective: This international multicentre cohort study aims to identify recurrence patterns and treatment of first and second recurrence in a large cohort of patients after pancreatic resection for adenocarcinoma arising from IPMN. Summary Background Data: Recurrence patterns and treatment of recurrence post resection of adenocarcinoma arising from IPMN are poorly explored. Method: Patients undergoing pancreatic resection for adenocarcinoma from IPMN between January 2010 to December 2020 at 18 pancreatic centres were identified. Survival analysis was performed by the Kaplan-Meier log rank test and multivariable logistic regression by Cox-Proportional Hazards modelling. Endpoints were recurrence (time-to, location, and pattern of recurrence) and survival (overall survival and adjusted for treatment provided). Results: Four hundred and fifty-nine patients were included (median, 70 y; IQR, 64-76; male, 54 percent) with a median follow-up of 26.3 months (IQR, 13.0-48.1 mo). Recurrence occurred in 209 patients (45.5 percent; median time to recurrence, 32.8 months, early recurrence [within 1 y], 23.2 percent). Eighty-three (18.1 percent) patients experienced a local regional recurrence and 164 (35.7 percent) patients experienced distant recurrence. Adjuvant chemotherapy was not associated with reduction in recurrence (HR 1.09; P =0.669) One hundred and twenty patients with recurrence received further treatment. The median survival with and without additional treatment was 27.0 and 14.6 months ( P <0.001), with no significant difference between treatment modalities. There was no significant difference in survival between location of recurrence ( P =0.401). Conclusion: Recurrence after pancreatic resection for adenocarcinoma arising from IPMN is frequent with a quarter of patients recurring within 12 months. Treatment of recurrence is associated with improved overall survival and should be considered.