Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2017; 23(35): 6420-6428
Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6420
Different clinical presentations of metachronous pulmonary metastases after resection of pancreatic ductal adenocarcinoma: Retrospective study and review of the literature
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
Martin Lovecek, Pavel Skalicky, Josef Chudacek, Marek Szkorupa, Dusan Klos, Radek Vrba, Roman Havlik, Department of Surgery I, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, 77520 Olomouc, Czech Republic
Hana Svebisova, Radmila Lemstrova, Department of Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, 77520 Olomouc, Czech Republic
Jiri Ehrmann, Department of Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, 77520 Olomouc, Czech Republic
Jiri Ehrmann, Bohuslav Melichar, Beatrice Mohelnikova-Duchonova, Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, 77520 Olomouc, Czech Republic
Bohuslav Melichar, Beatrice Mohelnikova-Duchonova, Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, 77520 Olomouc, Czech Republic
Tharani Yogeswara, Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University, 775220 Olomouc, Czech Republic
Author contributions: Lovecek M and Mohelnikova-Du-chonova B designed the research; Lovecek M, Skalicky P, Chudacek J, Szkorupa M, Svebisova H, Lemstrova R, Ehrmann J and Havlik R performed the research; Lovecek M, Klos D, Vrba R and Mohelnikova-Duchonova B analyzed the data; Lovecek M, Melichar B, Yogeswara T and Mohelnikova-Duchonova B wrote the paper; all authors critically revised the manuscript for important intellectual content.
Supported by the Ministry of Health of the Czech Republic, No. 16-28375A to Mohelnikova-Duchonova B.
Institutional review board statement: This study has been approved by the institutional Review Board at the University Hospital Olomouc.
Conflict-of-interest statement: The authors declare that they have 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: Beatrice Mohelnikova-Duchonova, MD, PhD, Associate Professor, Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, I.P. Pavlova 6, 77520 Olomouc, Czech Republic. d.beatrice@seznam.cz
Telephone: +420-775-270283 Fax: +420-588-442522
Received: May 12, 2017
Peer-review started: May 16, 2017
First decision: June 5, 2017
Revised: June 25, 2017
Accepted: August 1, 2017
Article in press: August 2, 2017
Published online: September 21, 2017
Abstract
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, pTNM 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, pTNM 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, χ2 test and survival functions computed by the Kaplan-Meier 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 subgroups with different prognosis which could be used for the selection of treatment strategy: isolated pulmonary oligometastases, isolated multiple pulmonary metastases and pulmonary metastases accompanied by other metastases.

CONCLUSION

Surgery should be considered for all patients with isolated pulmonary oligometastases, but the risk of intervention has to be individually weighted for each patient.

Keywords: Pancreatic cancer, Pulmonary metastases, Metachronous metastases, Surgical resection, Overall survival, Chemotherapy

Core tip: Metachronous pulmonary metastases represent the most frequent extraabdominal site of recurrence following radical resection for pancreas cancer. Three different clinical scenarios according to the presentations of metachronous pulmonary metastases were observed in our cohort: isolated oligometastases, multiple pulmonary metastases and pulmonary metastases accompanied by other metastases. Patients with isolated pulmonary metastases have the longest disease-free survival and overall survival. Surgery should be considered for all patients with isolated oligometastases.