Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma After Radical Resection

Overview

Journal Gastroenterol Res Pract

Publisher Wiley

Specialty Gastroenterology

Date 2022 Jun 13

PMID 35693325

Authors

Jingshu Tong

Shengdong Wu

Changjiang Lu

Yong Yang

Shuqi Mao

Caide Lu

Affiliations

Soon will be listed here.

Abstract

Background: Liver metastasis arises in many postoperative patients with PDAC, occurring in the early stage appears to lead to a very poor prognosis.

Objective: We aimed to analyze the risk factors for early liver metastasis after radical resection for patients with pancreatic ductal adenocarcinoma (PDAC) and to indicate the poor prognosis of early liver metastasis.

Methods: Patients who underwent pancreatectomy for PDAC at the Ningbo Medical Centre Lihuili Hospital between January 2015 and June 2021 were included. The exclusion criteria were death within 30 days after the operation, complications with other malignancies, and a positive final resection margin (R1). Liver metastasis and its occurrence time were recorded, and risk factors for early (≤6 months) liver metastasis were analyzed by logistic regression models. The prognosis of patients with early liver metastasis and different recurrence patterns was analyzed by Kaplan-Meier curves and the log-rank test.

Results: From the identified cohort of 184 patients, 172 patients were included for further analysis. 55 patients developed early liver metastasis within 6 months after the operation. Univariate analysis showed that CA125 ≥ 30 IU/ml, tumor size ≥ 4 cm, poor tumor differentiation, and portal vein/superior mesenteric vein (PV/SMV) reconstruction were risk factors, and multivariate analysis showed that poor tumor differentiation and PV/SMV reconstruction were independent risk factors for early liver metastasis. The prognosis of liver metastasis was the worst among the different recurrence patterns. Early liver metastasis indicates a poor prognosis in patients with PDAC.

Conclusions: Poor differentiation and PV/SMV reconstruction are independent risk factors for early liver metastasis in patients with PDAC, and early liver metastasis indicates a poor prognosis.

Citing Articles

Development and validation of a nomogram to predict liver metastasis for pancreatic ductal adenocarcinoma after radical resection.

Tong J, Jiang W, Mao S, Wu S, Lu C Front Oncol. 2022; 12:1040411.

PMID: 36479089 PMC: 9720266. DOI: 10.3389/fonc.2022.1040411.

Biomarkers in Liquid Biopsies for Prediction of Early Liver Metastases in Pancreatic Cancer.

Mehdorn A, Gemoll T, Busch H, Kern K, Beckinger S, Daunke T Cancers (Basel). 2022; 14(19).

PMID: 36230528 PMC: 9562670. DOI: 10.3390/cancers14194605.

References

Groot V, Gemenetzis G, Blair A, Rivero-Soto R, Yu J, Javed A . Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma. Ann Surg. 2019; 269(6):1154-1162. PMC: 6191366. DOI: 10.1097/SLA.0000000000002734. View

Chun Y, Pawlik T, Vauthey J . 8th Edition of the AJCC Cancer Staging Manual: Pancreas and Hepatobiliary Cancers. Ann Surg Oncol. 2017; 25(4):845-847. DOI: 10.1245/s10434-017-6025-x. View

Niedergethmann M, Hildenbrand R, Wostbrock B, Hartel M, Sturm J, Richter A . High expression of vascular endothelial growth factor predicts early recurrence and poor prognosis after curative resection for ductal adenocarcinoma of the pancreas. Pancreas. 2002; 25(2):122-9. DOI: 10.1097/00006676-200208000-00002. View

Addeo P, Velten M, Averous G, Faitot F, Nguimpi-Tambou M, Nappo G . Prognostic value of venous invasion in resected T3 pancreatic adenocarcinoma: Depth of invasion matters. Surgery. 2017; 162(2):264-274. DOI: 10.1016/j.surg.2017.03.008. View

Tien Y, Kuo H, Ho B, Chang M, Chang Y, Cheng M . A High Circulating Tumor Cell Count in Portal Vein Predicts Liver Metastasis From Periampullary or Pancreatic Cancer: A High Portal Venous CTC Count Predicts Liver Metastases. Medicine (Baltimore). 2016; 95(16):e3407. PMC: 4845834. DOI: 10.1097/MD.0000000000003407. View

Chua T, Saxena A . Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg. 2010; 14(9):1442-52. DOI: 10.1007/s11605-009-1129-7. View

Sugiura T, Uesaka K, Kanemoto H, Mizuno T, Sasaki K, Furukawa H . Serum CA19-9 is a significant predictor among preoperative parameters for early recurrence after resection of pancreatic adenocarcinoma. J Gastrointest Surg. 2012; 16(5):977-85. DOI: 10.1007/s11605-012-1859-9. View

Tsilimigras D, Brodt P, Clavien P, Muschel R, DAngelica M, Endo I . Liver metastases. Nat Rev Dis Primers. 2021; 7(1):27. DOI: 10.1038/s41572-021-00261-6. View

Zheng B, Ohuchida K, Yan Z, Okumura T, Ohtsuka T, Nakamura M . Primary Recurrence in the Lung is Related to Favorable Prognosis in Patients with Pancreatic Cancer and Postoperative Recurrence. World J Surg. 2017; 41(11):2858-2866. DOI: 10.1007/s00268-017-4068-6. View

10.

Matsumoto I, Murakami Y, Shinzeki M, Asari S, Goto T, Tani M . Proposed preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after surgical resection: A multi-center retrospective study. Pancreatology. 2015; 15(6):674-80. DOI: 10.1016/j.pan.2015.09.008. View

11.

Kleeff J, Reiser C, Hinz U, Bachmann J, Debus J, Jaeger D . Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg. 2007; 245(4):566-72. PMC: 1877037. DOI: 10.1097/01.sla.0000245845.06772.7d. View

12.

Ferrone C, Brennan M, Gonen M, Coit D, Fong Y, Chung S . Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg. 2007; 12(4):701-6. DOI: 10.1007/s11605-007-0384-8. View

13.

Ferrone C, Pieretti-Vanmarcke R, Bloom J, Zheng H, Szymonifka J, Wargo J . Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery. 2012; 152(3 Suppl 1):S43-9. PMC: 3806092. DOI: 10.1016/j.surg.2012.05.020. View

14.

Hishinuma S, Ogata Y, Tomikawa M, Ozawa I, Hirabayashi K, Igarashi S . Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings. J Gastrointest Surg. 2006; 10(4):511-8. DOI: 10.1016/j.gassur.2005.09.016. View

15.

Schwarz C, Fitschek F, Primavesi F, Stattner S, Margonis G, Weiss M . Metachronous hepatic resection for liver only pancreatic metastases. Surg Oncol. 2020; 35:169-173. DOI: 10.1016/j.suronc.2020.08.005. View

16.

Shibata K, Matsumoto T, Yada K, Sasaki A, Ohta M, Kitano S . Factors predicting recurrence after resection of pancreatic ductal carcinoma. Pancreas. 2005; 31(1):69-73. DOI: 10.1097/01.mpa.0000166998.04266.88. View

17.

de Ridder J, de Wilt J, Simmer F, Overbeek L, Lemmens V, Nagtegaal I . Incidence and origin of histologically confirmed liver metastases: an explorative case-study of 23,154 patients. Oncotarget. 2016; 7(34):55368-55376. PMC: 5342423. DOI: 10.18632/oncotarget.10552. View

18.

Sho M, Tanaka T, Yamada T, Nomi T, Akahori T, Doh J . Novel postoperative adjuvant strategy prevents early hepatic recurrence after resection of pancreatic cancer. J Hepatobiliary Pancreat Sci. 2010; 18(2):235-9. DOI: 10.1007/s00534-010-0336-7. View

19.

Hashimoto A, Nishiofuku H, Tanaka T, Sho M, Anai H, Nakajima Y . Safety and optimal management of hepatic arterial infusion chemotherapy after pancreatectomy for pancreatobiliary cancer. AJR Am J Roentgenol. 2012; 198(4):923-30. DOI: 10.2214/AJR.11.6751. View

20.

Huang J, Lok V, Ngai C, Zhang L, Yuan J, Lao X . Worldwide Burden of, Risk Factors for, and Trends in Pancreatic Cancer. Gastroenterology. 2020; 160(3):744-754. DOI: 10.1053/j.gastro.2020.10.007. View