Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial

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Jones, Robert P.Royal Liverpool Univ Hosp, Liverpool, Merseyside, England (author)

Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma : A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial

Article/chapterEnglish2019

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AMER MEDICAL ASSOC,2019
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LIBRIS-ID:oai:DiVA.org:uu-400831
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-400831URI
https://doi.org/10.1001/jamasurg.2019.3337DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:142459140URI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Importance: The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma with adjuvant chemotherapy remain unclear.Objective: To define patterns of recurrence after adjuvant chemotherapy and the association with survival.Design, Setting, and Participants: Prospectively collected data from the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial, an international multicenter study. The study included 730 patients who had resection and adjuvant chemotherapy for pancreatic cancer. Data were analyzed between July 2017 and May 2019.Interventions: Randomization to adjuvant gemcitabine or gemcitabine plus capecitabine.Main Outcomes and Measures: Overall survival, recurrence, and sites of recurrence.Results: Of the 730 patients, median age was 65 years (range 37-81 years), 414 were men (57%), and 316 were women (43%). The median follow-up time from randomization was 43.2 months (95% CI, 39.7-45.5 months), with overall survival from time of surgery of 27.9 months (95% CI, 24.8-29.9 months) with gemcitabine and 30.2 months (95% CI, 25.8-33.5 months) with the combination (HR, 0.81; 95% CI, 0.68-0.98; P=.03). The 5-year survival estimates were 17.1% (95% CI, 11.6%-23.5%) and 28.0% (22.0%-34.3%), respectively. Recurrence occurred in 479 patients (65.6%); another 78 patients (10.7%) died without recurrence. Local recurrence occurred at a median of 11.63 months (95% CI, 10.05-12.19 months), significantly different from those with distant recurrence with a median of 9.49 months (95% CI, 8.44-10.71 months) (HR, 1.21; 95% CI, 1.01-1.45; P=.04). Following recurrence, the median survival was 9.36 months (95% CI, 8.08-10.48 months) for local recurrence and 8.94 months (95% CI, 7.82-11.17 months) with distant recurrence (HR, 0.89; 95% CI, 0.73-1.09; P=.27). The median overall survival of patients with distant-only recurrence (23.03 months; 95% CI, 19.55-25.85 months) or local with distant recurrence (23.82 months; 95% CI, 17.48-28.32 months) was not significantly different from those with only local recurrence (24.83 months; 95% CI, 22.96-27.63 months) (P=.85 and P=.35, respectively). Gemcitabine plus capecitabine had a 21% reduction of death following recurrence compared with monotherapy (HR, 0.79; 95% CI, 0.64-0.98; P=.03).Conclusions and Relevance: There were no significant differences between the time to recurrence and subsequent and overall survival between local and distant recurrence. Pancreatic cancer behaves as a systemic disease requiring effective systemic therapy after resection.Trial Registration: ClinicalTrials.gov identifier: NCT00058201, EudraCT 2007-004299-38, and ISRCTN 96397434. This secondary analysis of a randomized clinical trial investigates patterns of recurrence after adjuvant chemotherapy in pancreatic cancer and the association with survival.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng

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Psarelli, Eftychia-EiriniUniv Liverpool, Liverpool, Merseyside, England (author)
Jackson, RichardUniv Liverpool, Liverpool, Merseyside, England (author)
Ghaneh, PaulaRoyal Liverpool Univ Hosp, Liverpool, Merseyside, England;Univ Liverpool, Liverpool, Merseyside, England (author)
Halloran, Christopher M.Royal Liverpool Univ Hosp, Liverpool, Merseyside, England;Univ Liverpool, Liverpool, Merseyside, England (author)
Palmer, Daniel H.Univ Liverpool, Liverpool, Merseyside, England;Clatterbridge Canc Ctr, Wirral, Merseyside, England (author)
Campbell, FionaRoyal Liverpool Univ Hosp, Liverpool, Merseyside, England (author)
Valle, Juan W.Univ Manchester Christie, Manchester, Lancs, England (author)
Faluyi, OlusolaClatterbridge Canc Ctr, Wirral, Merseyside, England (author)
O'Reilly, Derek A.Manchester Univ Fdn Trust, Manchester, Lancs, England (author)
Cunningham, DavidRoyal Marsden Hosp, London, England (author)
Wadsley, JonathanWeston Pk Hosp, Sheffield, S Yorkshire, England (author)
Darby, SuzanneWeston Pk Hosp, Sheffield, S Yorkshire, England (author)
Meyer, TimRoyal Free Hosp, London, England (author)
Gillmore, RoopinderRoyal Free Hosp, London, England (author)
Anthoney, AlanSt James Univ Hosp, Leeds, W Yorkshire, England (author)
Lind, PehrKarolinska Institutet (author)
Glimelius, BengtUppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD)(Swepub:uu)bengglim (author)
Falk, StephenBristol Haematol & Oncol Ctr, Bristol, Avon, England (author)
Izbicki, Jakob R.Univ Hamburg, Med Inst UKE, Hamburg, Germany (author)
Middleton, Gary WilliamRoyal Surrey Cty Hosp, Guildford, Surrey, England (author)
Cummins, SebastianRoyal Surrey Cty Hosp, Guildford, Surrey, England (author)
Ross, Paul J.Guys Hosp, London, England (author)
Wasan, HarpreetHammersmith Hosp, London, England (author)
McDonald, AlecBeatson West Scotland Canc Ctr, Glasgow, Lanark, Scotland (author)
Crosby, TomVelindre Hosp, Cardiff, S Glam, Wales (author)
Ting, YukQueen Elizabeth Hosp, Birmingham, W Midlands, England (author)
Patel, KinnariChurchill Hosp, Oxford, England (author)
Sherriff, DavidDerriford Hosp, Plymouth, Devon, England (author)
Soomal, RubinJersey Gen Hosp, Jersey, England (author)
Borg, DavidSkane Univ Hosp, Lund, Sweden;Skane Univ Hosp, Malmo, Sweden (author)
Sothi, SharmilaUniv Hosp Coventry, Coventry, W Midlands, England (author)
Hammel, PascalHop Beaujon, Clichy, France (author)
Lerch, Markus M.Greifswald Univ, Med, Greifswald, Germany (author)
Mayerle, JuliaGreifswald Univ, Med, Greifswald, Germany;Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Munich, Germany (author)
Tjaden, ChristineHeidelberg Univ, Heidelberg, Germany (author)
Strobel, OliverHeidelberg Univ, Heidelberg, Germany (author)
Hackert, ThiloHeidelberg Univ, Heidelberg, Germany (author)
Buchler, Markus W.Heidelberg Univ, Heidelberg, Germany (author)
Neoptolemos, John P.Heidelberg Univ, Heidelberg, Germany (author)
Hill, MarkKent Oncol Ctr, Maidstone, Kent, England (author)
Corrie, PippaAddenbrookes Hosp, Cambridge, England (author)
Hickish, TamasRoyal Bournemouth Hosp, Bournemouth, Dorset, England (author)
Napier, MarkNorth Devon Dist Hosp Barnstaple, Barnstaple, England (author)
Slater, SarahSt Bartholomews Hosp, London, England (author)
Valle, JuanNorth Manchester Gen Hosp, Manchester, Lancs, England (author)
Shablak, AlaaeldinSalisbury Dist Hosp, Salisbury, Wilts, England (author)
Cunnell, MichelleNottingham City Hosp, Nottingham, England (author)
Guimbaud, RosineCHU Purpan, Toulouse, France (author)
Roques, TomNorfolk & Norwich Univ Hosp, Norwich, Norfolk, England (author)
Iveson, TimSouthampton Gen Hosp, Southampton, Hants, England (author)
Jamil, ArshadUniv Hosp North Staffordshire, Stoke, England;Leighton Hosp, Crewe, England (author)
Robinson, AngusConquest Hosp, Hastings, England (author)
Garcia-Alonso, AngelGlan Clwyd Gen Hosp, Rhyl, Wales (author)
Chang, DavidRoyal Blackburn Hosp, Blackburn, Lancs, England (author)
Tsang, DavidSouthend Hosp, Westcliff On Sea, England (author)
Wadd, NickJames Cook Univ Hosp, Middlesbrough, Cleveland, England (author)
Wall, LucyWestern Gen Hosp, Edinburgh, Midlothian, Scotland (author)
Nielsen, Niels HilmerNorrlands Univ Sjukhus, Umea, Sweden (author)
Lerch, MarkusErnst Moritz Arndt Univ Greifswald, Greifswald, Germany (author)
Mehta, AjayRoyal Preston Hosp, Preston, Lancs, England (author)
Sivaramalingam, MuthiahBlackpool Victoria Hosp, Blackpool, England (author)
Fyfe, DavidRoyal Lancaster Infirm, Lancaster, England (author)
Osborne, RichardPoole Hosp, Poole, Dorset, England (author)
Blesing, ClaireGreat Western Hosp, Swindon, Wilts, England (author)
Bulusu, Venkata RameshBedford Hosp, Bedford, England (author)
Rathbone, EmmaHuddersfield Royal Infirm, Huddersfield, W Yorkshire, England (author)
Seitz, Jean-FrancoisCHU La Timone, Marseille, France (author)
Beaumont, EricaYeovil Dist Hosp, Yeovil, England (author)
Dernedde, UlrikeJames Paget Hosp, Great Yarmouth, England (author)
McAdam, KarenPeterborough City Hosp, Peterborough, Cambs, England (author)
Dimopoulos, ProkopiosSt Marys Hosp, Newport, Wight, England (author)
Cominos, MathildaQueen Elizabeth Queen Mother Hosp, Margate, England;William Harvey Hosp, Ashford, Kent, England (author)
Askill, ColinSingleton Hosp, Swansea, England (author)
Piwowar, AndrzejVastmanlands Sjukhus, Vasteras, Sweden (author)
Bachet, Jean-BaptisteGrp Hosp Pitie Salpetriere, Paris, France (author)
Sumpter, KateFreeman Rd Hosp, Newcastle, England (author)
Raouf, SherifQueens Hosp, Romford, Essex, England (author)
Nicoll, JonathanCumberland Infirm, Carlisle, England (author)
Rees, CharlotteBasingstoke & North Hampshire Hosp, Basingstoke, Hants, England (author)
Dhinakaran, KathirveluRoyal Shrewsbury Hosp, Shrewsbury, Salop, England (author)
Haux, JohanUniv Sjukhuset Linkoping, Linkoping, Sweden (author)
Bengrine-Lefevre, LeilaHop St Antoine, Paris, France (author)
Terrebonne, EricHop Haut Leveque, Pessac, France (author)
Shankland, CatherineRoyal Derby Hosp, Derby, England (author)
Palmer, CherylHinchingbrooke Hosp, Huntingdon, England (author)
Medley, LouiseTorbay Hosp, Torquay, England (author)
Toy, ElizabethRoyal Devon & Exeter Hosp, Exeter, Devon, England (author)
Kaur, JasvinderDarent Valley Hosp, Dartford, England (author)
Gupta, KamalnayanAlexandra Hosp, Redditch, England (author)
Cheeseman, SueBradford Royal Infirm, Bradford, W Yorkshire, England (author)
Patterson, DanielWest Suffolk Hosp, Bury St Edmunds, Suffolk, England (author)
Candish, CharlesCheltenham Gen Hosp, Cheltenham, Glos, England (author)
Thompson, JoyceHeartlands Hosp, Birmingham, W Midlands, England (author)
Coxon, FareedaBishop Auckland Gen Hosp, Bishop Auckland, England;Darlington Mem Hosp, Darlington, Durham, England (author)
Connolly, CarolineStafford Hosp, Stafford, England (author)
McPhail, NeilRaigmore Hosp, Inverness, Scotland (author)
Williams, RachelYsbyty Gwynedd, Bangor, Gwynedd, Wales (author)
Flygare, PetraLanssjukhuset Sundsvall, Sundsvall, Sweden (author)
Elmlund, MattiasCent Sjukhuset Karlstad, Karlstad, Sweden (author)
Artru, PascalHop Prive Jean Mermoz, Lyon, France (author)
Millat, BertrandHop St Eloi, Montpellier, France (author)
Royal Liverpool Univ Hosp, Liverpool, Merseyside, EnglandUniv Liverpool, Liverpool, Merseyside, England (creator_code:org_t)

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In:JAMA Surgery: AMER MEDICAL ASSOC154:11, s. 1038-10482168-62542168-6262

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By the author/editor: Jones, Robert P.; Psarelli, Eftych ...; Jackson, Richard; Ghaneh, Paula; Halloran, Christ ...; Palmer, Daniel H ...; show more...; Campbell, Fiona; Valle, Juan W.; Faluyi, Olusola; O'Reilly, Derek ...; Cunningham, Davi ...; Wadsley, Jonatha ...; Darby, Suzanne; Meyer, Tim; Gillmore, Roopin ...; Anthoney, Alan; Lind, Pehr; Glimelius, Bengt; Falk, Stephen; Izbicki, Jakob R ...; Middleton, Gary ...; Cummins, Sebasti ...; Ross, Paul J.; Wasan, Harpreet; McDonald, Alec; Crosby, Tom; Ting, Yuk; Patel, Kinnari; Sherriff, David; Soomal, Rubin; Borg, David; Sothi, Sharmila; Hammel, Pascal; Lerch, Markus M.; Mayerle, Julia; Tjaden, Christin ...; Strobel, Oliver; Hackert, Thilo; Buchler, Markus ...; Neoptolemos, Joh ...; Hill, Mark; Corrie, Pippa; Hickish, Tamas; Napier, Mark; Slater, Sarah; Valle, Juan; Shablak, Alaaeld ...; Cunnell, Michell ...; Guimbaud, Rosine; Roques, Tom; Iveson, Tim; Jamil, Arshad; Robinson, Angus; Garcia-Alonso, A ...; Chang, David; Tsang, David; Wadd, Nick; Wall, Lucy; Nielsen, Niels H ...; Lerch, Markus; Mehta, Ajay; Sivaramalingam, ...; Fyfe, David; Osborne, Richard; Blesing, Claire; Bulusu, Venkata ...; Rathbone, Emma; Seitz, Jean-Fran ...; Beaumont, Erica; Dernedde, Ulrike; McAdam, Karen; Dimopoulos, Prok ...; Cominos, Mathild ...; Askill, Colin; Piwowar, Andrzej; Bachet, Jean-Bap ...; Sumpter, Kate; Raouf, Sherif; Nicoll, Jonathan; Rees, Charlotte; Dhinakaran, Kath ...; Haux, Johan; Bengrine-Lefevre ...; Terrebonne, Eric; Shankland, Cathe ...; Palmer, Cheryl; Medley, Louise; Toy, Elizabeth; Kaur, Jasvinder; Gupta, Kamalnaya ...; Cheeseman, Sue; Patterson, Danie ...; Candish, Charles; Thompson, Joyce; Coxon, Fareeda; Connolly, Caroli ...; McPhail, Neil; Williams, Rachel; Flygare, Petra; Elmlund, Mattias; Artru, Pascal; Millat, Bertrand; show less...

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