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Different clinical presentations of metachronous pulmonary metastases after resection of pancreatic ductal adenocarcinoma: Retrospective study and review of the literature

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World Journal of Gastroenterology 2017年第35期23卷 6420-6428页

作者： Martin Lovecek Pavel Skalicky Josef Chudacek Marek Szkorupa Hana Svebisova Radmila Lemstrova Jiri Ehrmann Bohuslav Melichar tharani yogeswara Dusan Klos Radek Vrba Roman Havlik Beatrice Mohelnikova-Duchonova Department of Surgery I University Hospital Olomouc and Faculty of Medicine and DentistryPalacky University Department of Oncology University Hospital Olomouc and Faculty of Medicine and DentistryPalacky University Department of Molecular Pathology Faculty of Medicine and DentistryPalacky University OlomoucUniversity Hospital Olomouc Institute of Molecular and Translational Medicine Faculty of Medicine and DentistryPalacky University Department of Oncology Faculty of Medicine and DentistryPalacky University OlomoucUniversity Hospital Olomouc Department of Surgery I Faculty of Medicine and DentistryPalacky University

AIM To analyze pancreatic cancer patients who developed metachronous pulmonary metastases(MPM) as a first site of recurrence after the curative-intent surgery.METHODS One-hundred-fifty-nine consecutive pancreatic ductal adenocarcinoma(PDAC) patients who underwent radical pancreatic surgery between 2006 and 2013 were included in this retrospective analysis. The clinical data including age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered, and follow-up were all obtained from medical records. Further analysis covered only patients with metachronous metastases. Clinical and histopathological data(age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered and follow-up) of patients with metachronous non-pulmonary metastases and patients with metachronous pulmonary metastases were statistically assessed. Disease-free survival(DFS) from pancreas resection until metastases onset and overall survival(OS) were calculated. Wilcoxon test, χ~2 test and survival functions computed by the KaplanMeier method were used. Statistical significance was evaluated by the log-rank test using SPSS. A P-value of less than 0.05 was considered statistically significant.RESULTS Metachronous pulmonary metastases were observed in 20(16.9%) and were operable in 3(2.5%) of PDAC patients after a prior curative-intent surgery. Patients with isolated pulmonary metastases(oligometastases and multiple metastases) had estimated prior DFS and OS of 35.4 and 81.4 mo, respectively, and those with metachronous pulmonary metastases accompanied by other metastases had prior DFS and OS of 17.3 and 23.4 mo, respectively. Patients with non-pulmonary metastases had prior DFS and OS of 9.4 and 15.8 mo, respectively. Different clinical scenarios according to the presentation of MPM were observed and patients could be divided to three subgr

关键词： Pancreatic cancer Pulmonary metastases Metachronous metastases Surgical resection Overall survival Chemotherapy

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