Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands A Nationwide Analysis

L.A. Daamen; V.P. Groot; M.G. Besselink; K. Bosscha; O.R. Busch; G.A. Cirkel; R.M. van Dam; S. Festen; B.G. Koerkamp; N.H. Mohammad; E. van der Harst; I.H.J.T. de Hingh; M.P.W. Intven; G. Kazemier; M. Los; G.J. Meijer; V.E. de Meijer; V.B. Nieuwenhuijs; B.K. Pranger; M.G. Raicu; J.M.J. Schreinemakers; M.W.J. Stommel; R.C. Verdonk; H.M. Verkooijen; I.Q. Molenaar; H.C. van Santvoort; Dutch Pancreatic Canc Grp

doi:10.1097/sla.0000000000004093

Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands A Nationwide Analysis

L.A. Daamen^*, V.P. Groot, M.G. Besselink, K. Bosscha, O.R. Busch, G.A. Cirkel, R.M. van Dam, S. Festen, B.G. Koerkamp, N.H. Mohammad, E. van der Harst, I.H.J.T. de Hingh, M.P.W. Intven, G. Kazemier, M. Los, G.J. Meijer, V.E. de Meijer, V.B. Nieuwenhuijs, B.K. Pranger, M.G. RaicuJ.M.J. Schreinemakers, M.W.J. Stommel, R.C. Verdonk, H.M. Verkooijen, I.Q. Molenaar, H.C. van Santvoort^*, Dutch Pancreatic Canc Grp

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival. Summary of Background data: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence. Methods: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014-2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence. Results: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001]. Conclusions: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.

Original language	English
Pages (from-to)	769-775
Number of pages	7
Journal	Annals of Surgery
Volume	275
Issue number	4
DOIs	https://doi.org/10.1097/sla.0000000000004093
Publication status	Published - 1 Apr 2022

Keywords

ASSOCIATION
DUCTAL ADENOCARCINOMA
FOLFIRINOX
FOLLOW-UP
GEMCITABINE
GUIDELINES
ISOLATED LOCAL RECURRENCE
PDAC
RESECTION
SURVEILLANCE
THERAPY
disease recurrence
follow-up
pancreatic ductal adenocarcinoma
surveillance

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10.1097/sla.0000000000004093

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Daamen, L. A., Groot, V. P., Besselink, M. G., Bosscha, K., Busch, O. R., Cirkel, G. A., van Dam, R. M., Festen, S., Koerkamp, B. G., Mohammad, N. H., van der Harst, E., de Hingh, I. H. J. T., Intven, M. P. W., Kazemier, G., Los, M., Meijer, G. J., de Meijer, V. E., Nieuwenhuijs, V. B., Pranger, B. K., ... Dutch Pancreatic Canc Grp (2022). Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands A Nationwide Analysis. Annals of Surgery, 275(4), 769-775. https://doi.org/10.1097/sla.0000000000004093

@article{08e0a868ffc8496ca5beddea902c411a,

title = "Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands A Nationwide Analysis",

abstract = "Objective: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival. Summary of Background data: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence. Methods: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014-2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence. Results: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001]. Conclusions: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.",

keywords = "ASSOCIATION, DUCTAL ADENOCARCINOMA, FOLFIRINOX, FOLLOW-UP, GEMCITABINE, GUIDELINES, ISOLATED LOCAL RECURRENCE, PDAC, RESECTION, SURVEILLANCE, THERAPY, disease recurrence, follow-up, pancreatic ductal adenocarcinoma, surveillance",

author = "L.A. Daamen and V.P. Groot and M.G. Besselink and K. Bosscha and O.R. Busch and G.A. Cirkel and {van Dam}, R.M. and S. Festen and B.G. Koerkamp and N.H. Mohammad and {van der Harst}, E. and {de Hingh}, I.H.J.T. and M.P.W. Intven and G. Kazemier and M. Los and G.J. Meijer and {de Meijer}, V.E. and V.B. Nieuwenhuijs and B.K. Pranger and M.G. Raicu and J.M.J. Schreinemakers and M.W.J. Stommel and R.C. Verdonk and H.M. Verkooijen and I.Q. Molenaar and {van Santvoort}, H.C. and {Dutch Pancreatic Canc Grp}",

year = "2022",

month = apr,

day = "1",

doi = "10.1097/sla.0000000000004093",

language = "English",

volume = "275",

pages = "769--775",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "4",

}

Daamen, LA, Groot, VP, Besselink, MG, Bosscha, K, Busch, OR, Cirkel, GA, van Dam, RM, Festen, S, Koerkamp, BG, Mohammad, NH, van der Harst, E, de Hingh, IHJT, Intven, MPW, Kazemier, G, Los, M, Meijer, GJ, de Meijer, VE, Nieuwenhuijs, VB, Pranger, BK, Raicu, MG, Schreinemakers, JMJ, Stommel, MWJ, Verdonk, RC, Verkooijen, HM, Molenaar, IQ, van Santvoort, HC & Dutch Pancreatic Canc Grp 2022, 'Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands A Nationwide Analysis', Annals of Surgery, vol. 275, no. 4, pp. 769-775. https://doi.org/10.1097/sla.0000000000004093

TY - JOUR

T1 - Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands A Nationwide Analysis

AU - Daamen, L.A.

AU - Groot, V.P.

AU - Besselink, M.G.

AU - Bosscha, K.

AU - Busch, O.R.

AU - Cirkel, G.A.

AU - van Dam, R.M.

AU - Festen, S.

AU - Koerkamp, B.G.

AU - Mohammad, N.H.

AU - van der Harst, E.

AU - de Hingh, I.H.J.T.

AU - Intven, M.P.W.

AU - Kazemier, G.

AU - Los, M.

AU - Meijer, G.J.

AU - de Meijer, V.E.

AU - Nieuwenhuijs, V.B.

AU - Pranger, B.K.

AU - Raicu, M.G.

AU - Schreinemakers, J.M.J.

AU - Stommel, M.W.J.

AU - Verdonk, R.C.

AU - Verkooijen, H.M.

AU - Molenaar, I.Q.

AU - van Santvoort, H.C.

AU - Dutch Pancreatic Canc Grp

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Objective: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival. Summary of Background data: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence. Methods: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014-2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence. Results: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001]. Conclusions: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.

AB - Objective: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival. Summary of Background data: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence. Methods: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014-2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence. Results: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001]. Conclusions: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.

KW - ASSOCIATION

KW - DUCTAL ADENOCARCINOMA

KW - FOLFIRINOX

KW - FOLLOW-UP

KW - GEMCITABINE

KW - GUIDELINES

KW - ISOLATED LOCAL RECURRENCE

KW - PDAC

KW - RESECTION

KW - SURVEILLANCE

KW - THERAPY

KW - disease recurrence

KW - follow-up

KW - pancreatic ductal adenocarcinoma

KW - surveillance

U2 - 10.1097/sla.0000000000004093

DO - 10.1097/sla.0000000000004093

M3 - Article

C2 - 32773631

SN - 0003-4932

VL - 275

SP - 769

EP - 775

JO - Annals of Surgery

JF - Annals of Surgery

IS - 4

ER -

Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands A Nationwide Analysis

Abstract

Keywords

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