Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2016; 22(45): 10024-10037
Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.10024
Preoperative evaluation of pancreatic ductal adenocarcinoma with synchronous liver metastasis: Diagnosis and assessment of unresectability
Hao-Jun Shi, Chen Jin, De-Liang Fu
Hao-Jun Shi, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai 200040, China
Author contributions: Shi HJ contributed to the conception and design of the study, data acquisition, analysis and interpretation, drafting and revising the article, and final approval of the version to be published; Jin C and Fu DL contributed to the conception and design of the study and final approval of the article.
Supported by the National Natural Science Foundation of China, No. 81472221; Clinical key projects of the National Health and Family Planning-Oncology 2013-2015.
Institutional review board statement: The study was reviewed and approved by the Fudan University Huashan Hospital Ethical Committee and Institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: De-Liang Fu, MD, PhD, Professor, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, 12 Urumchi Middle Road, Shanghai 200040, China. surgeonfu@163.com
Telephone: +86-21-52887164 Fax: +86-21-52888277
Received: August 4, 2016
Peer-review started: August 5, 2016
First decision: September 5, 2016
Revised: September 9, 2016
Accepted: October 19, 2016
Article in press: October 19, 2016
Published online: December 7, 2016
Abstract
AIM

To identify predictors for synchronous liver metastasis from resectable pancreatic ductal adenocarcinoma (PDAC) and assess unresectability of synchronous liver metastasis.

METHODS

Retrospective records of PDAC patients with synchronous liver metastasis who underwent simultaneous resections of primary PDAC and synchronous liver metastasis, or palliative surgical bypass, were collected from 2007 to 2015. A series of pre-operative clinical parameters, including tumor markers and inflammation-based indices, were analyzed by logistic regression to figure out predictive factors and assess unresectability of synchronous liver metastasis. Cox regression was used to identify prognostic factors in liver-metastasized PDAC patients after surgery, with intention to validate their conformance to the indications of simultaneous resections and palliative surgical bypass. Survival of patients from different groups were analyzed by the Kaplan-Meier method. Intra- and post-operative courses were compared, including complications. PDAC patients with no distant metastases who underwent curative resection served as the control group.

RESULTS

CA125 > 38 U/mL (OR = 12.397, 95%CI: 5.468-28.105, P < 0.001) and diabetes mellitus (OR = 3.343, 95%CI: 1.539-7.262, P = 0.002) independently predicted synchronous liver metastasis from resectable PDAC. CA125 > 62 U/mL (OR = 5.181, 95%CI: 1.612-16.665, P = 0.006) and age > 62 years (OR = 3.921, 95%CI: 1.217-12.632, P = 0.022) correlated with unresectability of synchronous liver metastasis, both of which also indicated a worse long-term outcome of liver-metastasized PDAC patients after surgery. After the simultaneous resections, patients with post-operatively elevated serum CA125 levels had shorter survival than those with post-operatively reduced serum CA125 levels (7.7 mo vs 16.3 mo, P = 0.013). The survival of liver-metastasized PDAC patients who underwent the simultaneous resections was similar to that of non-metastasized PDAC patients who underwent curative pancreatectomy alone (7.0 mo vs 16.9 mo, P < 0.001), with no higher rates of either pancreatic fistula (P = 0.072) or other complications (P = 0.230) and no greater impacts on length of hospital stay (P = 0.602) or post-operative diabetic control (P = 0.479).

CONCLUSION

The criterion set up by CA125 levels could facilitate careful diagnosis of synchronous liver metastases from PDAC, and prudent selection of appropriate patients for the simultaneous resections.

Keywords: CA125, Pancreatic ductal adenocarcinoma, Liver metastasis, Unresectability, Prognosis

Core tip: The presence of liver metastasis from pancreatic ductal adenocarcinoma (PDAC) usually deprives patients of opportunities for resection of PDAC. We utilized a series of clinical parameters for pre-operative evaluation of PDAC with synchronous liver metastasis, including diagnosis and assessment of unresectability. The criterion set up by serum CA125 levels could facilitate the careful judgement of the occurrence of synchronous liver metastases from PDAC, and the prudent selection of appropriate patients for simultaneous resections for primary PDAC and synchronous liver metastasis, for the sake of prolonged survival and substantial reduction in morbidity and mortality.