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Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer.

ABSTRACT: Background: Pancreatic cancer is a catastrophic disease with high recurrence and death rates, even in early stages. Early detection and early treatment improve survival in many cancer types but have not yet been clearly documented to do so in pancreatic cancer. In this study, we assessed the benefit on survival resulting from different patterns of surveillance in daily practice after curative surgery of early pancreatic cancer. Methods: Patients with pancreatic ductal adenocarcinoma who had received curative surgery between January 2000 and December 2013 at our institute were retrospectively reviewed. Patients were classified into one of four groups, based on surveillance strategy: the symptom group, the imaging group, the marker group (carbohydrate antigen 19-9 and/or carcinoembryonic antigen), and the intense group (both imaging and tumor marker assessment). Overall survival (OS), relapse-free survival (RFS), and post-recurrence overall survival (PROS) were evaluated. Results: One hundred and eighty-one patients with documented recurrence or metastasis were included in our analysis. The median OS for patients in the symptom group, imaging group, marker group, and intense group were 21.4 months, 13.9 months, 20.5 months, and 16.5 months, respectively (p = 0.670). Surveillance with imaging, tumor markers, or both was not an independent risk factor for OS in univariate and multivariate analyses. There was no significant difference in median RFS (symptom group, 11.7 months; imaging group, 6.3 months; marker group, 9.3 months; intense group, 6.9 months; p = 0.259) or median PROS (symptom group, 6.9 months; imaging group, 7.5 months; marker group, 5.0 months; intense group, 7.8 months; p = 0.953) between the four groups. Multivariate analyses identified poor Eastern Cooperative Oncology Group Performance Status (ECOG PS) (≥1), primary tumor site (tail), and tumor grade (poor differentiation) were poor prognostic factors for OS. Conclusions: Surveillance with regular imaging, tumor marker, or both was not an independent risk factor for OS of pancreatic cancer patients who undergo curative tumor resection.

SUBMITTER: Wu H

PROVIDER: S-EPMC6722558 | biostudies-other | 2019 Jul

REPOSITORIES: biostudies-other

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Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer.

Wu Hsu H Guo Jhe-Cyuan JC Yang Shih-Hung SH Tien Yu-Wen YW Kuo Sung-Hsin SH

Journal of clinical medicine 20190727 8

<b>Background</b>: Pancreatic cancer is a catastrophic disease with high recurrence and death rates, even in early stages. Early detection and early treatment improve survival in many cancer types but have not yet been clearly documented to do so in pancreatic cancer. In this study, we assessed the benefit on survival resulting from different patterns of surveillance in daily practice after curative surgery of early pancreatic cancer. <b>Methods</b>: Patients with pancreatic ductal adenocarcinom ...[more]

PMID: 31357636

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Project description:Pancreatic cancer is the fourth leading cancer-related death in United States. The clinical relevance of genomic imbalances in pancreatic cancer is uncertain. We performed array-comparative genomic hybridization (aCGH) in 44 resected pancreatic cancer specimens from a Korean cohort. We observed recurrent copy number gains were observed in chromosome 1q, 11q, 18q11.1-11.2, and 20q13.13; and losses in chromosome 2p, 9p, 10q, 14q, 15q, 18q12.2-23, 19q, 20q11.1, 21p, and 22q. High copy number gains, with log2 ratio >2.0, were observed in 4 cytobands, encoding genes such as G protein-coupled receptor 48, c-myc and gamma-catenin. By comparing the aCGH results of long survivors and short survivors, determined according to the median survival, we observed that loss of cytoband 18q22.3, encoding 5 genes, was the only alteration with significantly different frequencies. The copy number of the CPGL (Carboxypeptidase of glutamate-like) gene in cytoband 18q22.3 was found to be significantly associated with overall survival in univariate analyses (p=0.019 by log-rank test). This was subsequently assessed in the Italian cohort: 41 out of the 61 specimens carried deletion of the CPGL gene. Patients with deletion of the CPGL gene also had shorter overall survival (p=0.003 by log-rank test). Multivariate analysis of the two cohorts combined showed that loss of 18q22.3 / deletion of the CPGL gene was an independent poor prognostic factor for overall survival after adjusting for other factors which were found to impact the outcome (hazard ratio 2.72, p=0.0007). overexpression of the CPGL or its alternating splicing isoform CPGL-B in a pancreatic cancer cell lines resulted in slower proliferation of cells, G1 cell cycle arrest, and reduced migration activity. In conclusion, through aCGH analysis, we identified loss of 18q22.3 / deletion of the CPGL gene as potentially being an independent poor prognostic factor in resected pancreatic cancer. We further identified the CPGL gene as a potential tumor suppressor for pancreatic cancer cell lines. Array-comparative genomic hybridization was performed in 44 resected pancreatic cancer specimen from a Korean cohort. Genomic alteration relating to prognosis of the Korean cohort was further validated in a Italian cohort containing 61 resected pancreatic cancer specimens.

Project description:BackgroundRecent studies have found that muscle depletion may be a prognostic predictor in patients with pancreatic cancer (PC). However, in these studies, limited data were used to assess the relationship between the serial change in body composition and outcomes after PC resection. Hence, we evaluated the changes in body composition during the perioperative period in patients with PC and their association with the overall survival (OS).MethodsA total of 89 patients with PC who received surgery with curative intent between 2006 and 2015 were included in this study retrospectively. These patients underwent serial computed tomography (CT) scans: preoperatively, immediately after surgery (4 weeks), and 12 and 24 weeks after resection. The muscle and visceral fat areas were measured at the third lumbar vertebra level on cross-sectional CT images using sliceOmatic V5.0 program (TomoVision, Canada). The body composition ratio was determined by dividing the post-resection body composition at each point (4, 12, and 24 weeks) by the pre-resection body composition. Patients were divided into two groups-higher and lower groups-based on this body composition ratio (skeletal muscle mass ratio [SMR], visceral fat mass ratio [VFR]). The OS was compared between the two groups using the log-rank test.ResultsThe median age of patients was 63 (27-84) years, and the baseline body mass index was 23.0 (17.0-35.8) kg/m2. In the comparison of the SMR, there was no significant difference in the OS between the two groups at 4 and 12 weeks (4 weeks, P = 0.488; 12 weeks, P = 0.397). However, the higher group showed a longer OS than the lower group at 24 weeks (39 vs. 20 months, P = 0.008). Similarly, in the VFR, there was no significant difference in the OS between the two groups at 4 and 12 weeks (4 weeks, P = 0.732; 12 weeks, P = 0.060). However, the OS was longer in the higher group at 24 weeks (35 vs. 22 months, P = 0.023). When we analyzed the effect of muscle restoration at 24 weeks after resection on the OS by gender, there was no significant difference between the OS and SMR in the male group (P = 0.213), but a significant difference was noted in the female group (P = 0.002). In the multivariate Cox regression analysis, the SMR at 24 weeks after resection was significantly associated with the OS (P = 0.023) but not VFR at 24 weeks. In 69 patients without recurrence at 6 months, the SMR at 24 weeks was related to longer OS but without statistical significance (P = 0.07).ConclusionsThis study suggests that the restoration of muscle mass at 24 weeks after resection may be an independent prognostic factor for survival in patients with resected PC.

Project description:ImportanceA circulating tumor DNA (ctDNA) assay (Signatera; Natera) has been marketed for use in the surveillance of resected colorectal cancer despite limited data supporting such practice.ObjectiveTo compare a ctDNA assay with standard radiographic imaging and measurement of carcinoembryonic antigen (CEA) levels, per National Comprehensive Cancer Network guidelines, in the surveillance of resected colorectal cancer.Design, setting, and participantsThis retrospective, single-center cohort study evaluated surveillance strategies of ctDNA, imaging, and measurement of CEA levels in patients with resected colorectal cancer from September 1, 2019, to November 30, 2021.Main outcomes and measuresThe sensitivity and specificity of ctDNA, imaging, measurement of CEA levels, and combination of imaging plus measurement of CEA levels in detecting a confirmed recurrence of colorectal disease. A confirmed recurrence was defined as a positive ctDNA finding or a finding on imaging confirmed by biopsy, CEA level elevation, or subsequent tumor radiographic dynamics.ResultsA total of 48 patients with curatively resected colorectal cancer satisfied the inclusion criteria for this study (28 men [58.3%]; median age, 60 [IQR, 34-85] years) and underwent surveillance by ctDNA, imaging, and measurement of CEA levels. Fifteen patients had disease recurrence during surveillance. Positive ctDNA findings confirmed disease recurrence in 8 patients; imaging, in 9 patients; CEA levels, in 3 patients; and combined imaging plus CEA levels, in 11 patients. Numerically, ctDNA did not perform better than imaging in detecting recurrence, with sensitivities of 53.3% (95% CI, 27.4%-77.7%) and 60.0% (95% CI, 32.9%-82.5%), respectively (P > .99). The combination of imaging plus measurement of CEA levels (sensitivity, 73.3% [95% CI, 44.8%-91.1%]) had a numerical advantage compared with ctDNA in identifying recurrence (P = .55). In addition, no significant difference was noted among ctDNA (median, 14.3 months), imaging (median, 15.0 months), or imaging plus measurement of CEA levels (median, 15.0 months) in the time to identify disease recurrence.Conclusions and relevanceThe findings of this cohort study suggest that ctDNA assay may not provide advantages as a surveillance strategy compared with standard imaging combined with CEA levels when performed per National Comprehensive Cancer Network guidelines.

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Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer.

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Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer.

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