Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns

// Tamna Wangjam 1, 9 , Zhe Zhang 1, 6 , Xian Chong Zhou 1, 6 , Laxmi Lyer 1, 10 Farzana Faisal 1 , Kevin C. Soares 1, 2, 6 , Elliott Fishman 4, 6 , Ralph H. Hruban 1, 3, 6, 8 Joseph M. Herman 1, 5, 6 , Daniel Laheru 1, 6, 7 , Matthew Weiss 1, 2, 6 , Min Li 11 Ana De Jesus-Acosta 1, 6, 7 , Christopher L. Wolfgang 1, 2, 3, 6, 8 , Lei Zheng 1, 2, 6, 7, 8 1 Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 3 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 4 Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 5 Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 6 The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA 7 The Skip Viragh Center for Pancreatic Cancer, Johns Hopkins University School of Medicine, Baltimore, MD, USA 8 The Sol Goldman Pancreatic Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA 9 Division of Hematology and Oncology, University of Texas Health Science Center, San Antonio, TX, USA 10 Division of Hematology and Oncology, University of Maryland School of Medicine, Baltimore, MD, USA 11 University of Oklahoma Health Science Center, Oklahoma City, OK, USA Correspondence to: Lei Zheng, e-mail: lzheng6@jhmi.edu Christopher L. Wolfgang, e-mail: cwolfga2@jhmi.edu Ana De Jesus-Acosta, e-mail: adejesu1@jhmi.edu Keywords: pancreatic cancer, recurrent pattern, lung metastasis, prognosis Received: June 26, 2015      Accepted: August 28, 2015      Published: September 10, 2015 ABSTRACT The majority of patients with curative resection of pancreatic ductal adenocarcinoma recur within 5 years of resection. However, the prognosis associated with different patterns of recurrence has not been well studied. A retrospective review of patients who underwent curative surgical resection of pancreatic cancer was performed. Of the 209 patients, 174 patients developed recurrent disease. Of these 174, 28(16.1%) had recurrent disease limited to lung metastases, 20(11.5%) had recurrence in the lung plus one or more other sites excluding the liver, 73(42.0%) had liver metastasis alone or liver metastasis with any other site except lung, 28(16.1%) local recurrence only, and 25(14.3%) peritoneal recurrence alone or together with local recurrence. Patients with recurrence limited to lung had a 8.5 months(Mo) median survival from recurrence to death, which was significantly better than the survival associated with recurrence in the liver(5.1Mo), in the peritoneum(2.3Mo) or locally(5.1Mo) in multivariable analyses. Among all groups, the time from surgery to the diagnosis of recurrence in patients who recurred in only in the lung was also the longest. However, 75% of patients were found to have indeterminate lung nodules on their surveillance CT scans prior to the diagnosis of recurrence in lung. This delayed diagnosis of lung recurrence may have a negative impact on survival after recurrence. In conclusion, pancreatic cancer with lung recurrence has a significantly better prognosis than recurrence in other sites. Further studies are needed to investigate how different diagnostic and treatment modalities affect the survival of this unique subpopulation of pancreatic cancer patients.