Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Statistical Analysis
3. Results
3.1. Clinicopathological Features and Adjuvant Treatment
3.2. The Follow-Up and the Treatment Outcome of Four Surveillance Groups
3.3. Salvage Treatment for Recurrent Patients
3.4. Prognostic Factors
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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8 | Symptom Group (n = 44) | Imaging Group (n = 21) | Marker Group (n = 42) | Intense Group (n = 74) | p-Value | |||||
---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | |||
Age | Median | 72.5 | 70.3 | 65.1 | 66.0 | 0.069 ¶ | ||||
Gender | Male | 24 | 54.5% | 14 | 66.7% | 29 | 69.0% | 44 | 59.5% | 0.518 |
Female | 20 | 45.5% | 7 | 33.3% | 13 | 31.0% | 30 | 40.5% | ||
ECOG PS | 0 | 3 | 6.8% | 3 | 14.3% | 7 | 16.7% | 13 | 17.6% | 0.511 |
1 | 34 | 77.3% | 14 | 66.7% | 32 | 76.2% | 55 | 74.3% | ||
2 | 7 | 15.9% | 4 | 19.0% | 3 | 7.1% | 5 | 6.8% | ||
3 | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 1 | 1.4% | ||
Primary site | Head | 37 | 84.1% | 15 | 71.4% | 33 | 78.6% | 55 | 74.3% | 0.900 |
Body | 2 | 4.5% | 2 | 9.5% | 3 | 7.1% | 5 | 6.8% | ||
Tail | 5 | 11.4% | 4 | 19.5% | 6 | 14.3% | 14 | 18.9% | ||
Section margin | Negative | 33 | 75.0% | 15 | 71.4% | 36 | 85.7% | 59 | 79.7% | 0.510 |
Positive | 11 | 25.0% | 6 | 28.6% | 6 | 14.3% | 15 | 20.3% | ||
pT | T1 | 4 | 9.1% | 2 | 9.5% | 1 | 2.4% | 0 | 0.0% | 0.198 |
T2 | 6 | 13.6% | 3 | 14.3% | 5 | 11.9% | 9 | 12.2% | ||
T3 | 34 | 77.3% | 16 | 76.2% | 36 | 85.7% | 65 | 87.8% | ||
T4 | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | ||
pN | N0 | 24 | 54.5% | 10 | 47.6% | 23 | 54.8% | 34 | 45.9% | 0.736 |
N1 | 20 | 45.5% | 11 | 52.4% | 19 | 45.2% | 40 | 54.1% | ||
Differentiation | Grade 1 | 9 | 20.5% | 4 | 19.0% | 10 | 23.8% | 10 | 13.5% | 0.764 |
Grade 2 | 30 | 68.2% | 16 | 76.2% | 29 | 69.0% | 55 | 74.3% | ||
Grade 3 | 5 | 11.4% | 1 | 4.8% | 3 | 7.1% | 9 | 12.2% | ||
Adjuvant C/T | No | 40 | 90.9% | 18 | 85.7% | 27 | 64.3% | 41 | 55.4% | <0.001 * |
Yes | 4 | 9.1% | 3 | 14.3% | 15 | 35.7% | 33 | 44.6% | ||
Pattern of first R | Distant | 27 | 61.4% | 14 | 66.7% | 34 | 81.0% | 56 | 75.7% | 0.175 |
Local | 17 | 38.6% | 7 | 33.3% | 8 | 19.0% | 18 | 24.3% | ||
Treatment after R | No | 24 | 54.5% | 8 | 38.1% | 17 | 40.5% | 24 | 32.4% | 0.130 |
Yes | 20 | 45.5% | 13 | 61.9% | 25 | 59.5% | 50 | 67.6% | ||
CA199 post OP (U/mL) | Median | 19.5 | 37.85 | 24.8 | 38.4 | 0.149 ¶ | ||||
Elevated | 7 | 41.2% | 5 | 55.6% | 17 | 44.7% | 37 | 50.7% | 0.827 | |
Normal | 10 | 58.8% | 4 | 44.4% | 21 | 55.3% | 36 | 49.3% | ||
CEA post OP (ng/mL) | Median | 2.45 | 0.91 | 1.26 | 1.52 | 0.042 ¶ * | ||||
Elevated | 2 | 11.1% | 0 | 0.0% | 1 | 2.9% | 6 | 9.2% | 0.539 | |
Normal | 16 | 88.9% | 6 | 100.0% | 33 | 97.1% | 59 | 90.8% | ||
CA199 when R (U/mL) | Median | 209.71 | 1011.95 | 501 | 374.4 | 0.521¶ | ||||
Elevated | 27 | 81.8% | 9 | 75.0% | 30 | 81.1% | 55 | 78.6% | 0.950 | |
Normal | 6 | 18.2% | 3 | 25.0% | 7 | 18.9% | 15 | 21.4% | ||
CEA when R (ng/mL) | Median | 3.0 | 2.89 | 2.45 | 2.3 | 0.435 ¶ | ||||
Elevated | 12 | 40.0% | 2 | 22.2% | 10 | 33.3% | 15 | 23.4% | 0.366 | |
Normal | 18 | 60.0% | 7 | 77.8% | 20 | 66.7% | 49 | 76.6% |
Symptom Group | Imaging Group | Marker Group | Intense Group | p-Value | |
---|---|---|---|---|---|
Median OS (months) | 21.4 (95% CI: 17.9 to 25.0) | 13.9 (95% CI: 6.5 to 21.4) | 20.5 (95% CI: 13.5 to 27.5) | 16.5 (95% CI: 14.9 to 18.1) | 0.670 |
Median RFS (months) | 11.7 (95% CI: 8.9 to 14.5) | 6.3 (95% CI: 4.6 to 7.9) | 9.3 (95% CI: 7.5 to 11.1) | 6.9 (95% CI: 5.2 to 8.6) | 0.259 |
Median PROS (months) | 6.9 (95% CI: 2.9 to 10.9) | 7.5 (95% CI: 1.2 to 13.9) | 5.0 (95% CI: 3.0 to 7.0) | 7.8 (95% CI: 5.6 to 10.0) | 0.953 |
Univariate Analysis | Multivariate Analysis | |||||
---|---|---|---|---|---|---|
Hazard Ratio (HR) | 95.0% CI for HR | P-Value | Hazard Ratio (HR) | 95.0% CI for HR | P-Value | |
Adjuvant chemotherapy Yes vs. No | 1.003 | 0.696–1.445 | 0.988 | 0.925 | 0.596–1.436 | 0.728 |
ECOG PS 0 vs. ≥1 | 0.626 | 0.381–1.028 | 0.064 | 0.516 | 0.295–0.903 | 0.020 * |
Primary site Non-tail vs. tail | 0.930 | 0.599–1.445 | 0.747 | 0.599 | 0.360–0.997 | 0.049 * |
Section margin Positive vs. Negative | 1.230 | 0.817–1.852 | 0.322 | 1.128 | 0.736–1.729 | 0.581 |
T stage T1/T2 vs. T3 | 0.732 | 0.471–1.139 | 0.167 | 0.623 | 0.387–1.002 | 0.051 |
N stage N1 vs. N0 | 1.406 | 1.010–1.956 | 0.043 * | 1.368 | 0.961–1.947 | 0.082 |
Differentiation Grade 1/2 vs. Grade 3 | 0.595 | 0.353–1.002 | 0.051 | 0.553 | 0.322–0.950 | 0.032 * |
Treatment after recurrence Yes vs. No | 0.958 | 0.682–1.347 | 0.806 | 0.996 | 0.675–1.469 | 0.983 |
Follow up strategy | 0.985 | 0.831–1.167 | 0.862 | 0.996 | 0.837–1.184 | 0.960 |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Wu, H.; Guo, J.-C.; Yang, S.-H.; Tien, Y.-W.; Kuo, S.-H. Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer. J. Clin. Med. 2019, 8, 1115. https://doi.org/10.3390/jcm8081115
Wu H, Guo J-C, Yang S-H, Tien Y-W, Kuo S-H. Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer. Journal of Clinical Medicine. 2019; 8(8):1115. https://doi.org/10.3390/jcm8081115
Chicago/Turabian StyleWu, Hsu, Jhe-Cyuan Guo, Shih-Hung Yang, Yu-Wen Tien, and Sung-Hsin Kuo. 2019. "Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer" Journal of Clinical Medicine 8, no. 8: 1115. https://doi.org/10.3390/jcm8081115