MethodsClinical data of 172 patients who underwent radical resection of pancreatic cancer and were pathologically confirmed as pancreatic ductal adenocarcinoma in Ningbo University Affiliated Lihuili Hospital from January 2015 to June 2021 were analyzed retrospectively. According to the classification of the initial recurrence or metastasis after operation: no recurrence, local recurrence (residual pancreas, mesenteric vein, pancreaticoenterostomy surrounding tissue), liver metastasis, abdominal or retroperitoneum metastasis, multiple site recurrence and other pattern recurrence. The effect on prognosis was analyzed by COX risk ratio model, the overall survival and recurrence-free survival were calculated by Kaplan-Meier, and the survival curve was drawn. Log-rank test was used to compare the survival rate of different recurrence sites and different treatments after recurrence.
Results12 patients had local recurrence, 69 had liver metastasis, 25 had abdominal or retroperitoneal metastasis, 17 had multiple site recurrence, and 5 had other site recurrence and 44 had no recurrence. The median follow-up time was 15.5 months (3-69 months). The median overall survival was 19 months (95% CI 16.273-21.727). The 1- , 3- and 5-year postoperative cumulative survival rate was 71.0%, 27.8% and 20.2%, respectively. Univariate analysis showed that CA125, tumor size, lymph node metastasis, microvascular invasion, tumor differentiation degree, adjuvant chemotherapy, initial recurrence site were significantly correlated with overall survival (All P value <0.05). Multivariate analysis showed that CA125 ≥30 IU/ml (OR=2.669, P=0.001), microvascular invasion (OR=1.736, P=0.028), poor tumor differentiation (OR=1.604, P=0.027), adjuvant chemotherapy (OR=0.439, P<0.001), initial recurrence site (All P value <0.05) were the independent risk factors for overall survival. The median recurrence-free survival of 172 patients was 9 months (95% CI 7.075-10.925). Univariate analysis showed that CA125, tumor size, lymph node metastasis and microvascular invasion were significantly correlated with recurrence-free survival (All P value <0.05). Multivariate analysis showed that CA125 (OR=1.640, P=0.026), tumor size (OR=1.774, P=0.011) and microvascular invasion (OR=1.563, P=0.034) were the independent risk factors for recurrence-free survival. After surgery, the median survival time of patients with local recurrence, other pattern recurrence, abdominal or retroperitoneal metastasis, multi-site recurrence and liver metastasis was 28, 22, 21, 15 and 14 months, respectively. Among them, the overall survival of patients with postoperative local recurrence was longest, which was significantly longer than that of patients with multi-site recurrence (P=0.035) and liver metastasis (P=0.007); the survival of patients with abdominal or retroperitoneal metastasis was also longer than that with liver metastasis (P=0.005); and all the differences were statistically significant. In 128 patients with recurrence, the median overall survival of 26 patients without adjuvant therapy was 10 months (95% CI 6.877-13.123); the median overall survival of 68 patients with adjuvant chemotherapy was 15 months (95% CI 13.013-16.987); the median overall survival of 34 patients with comprehensive treatment of surgery and radiotherapy was 19 months (95% CI 15.100-22.900), which was significantly higher than the other two groups, and there were significant statistical differences among the three groups (P<0.001).
ConclusionsThe initial recurrence site of pancreatic cancer after radical operation is an independent risk factor for overall survival. Compared with local recurrence and abdominal or retroperitoneal metastasis, patients with multi-site recurrence and liver metastasis have a poor prognosis. Comprehensive treatment after recurrence can significantly prolong the overall survival.
