Objective: To elucidate the prognostic differences and risk factors associated with different patterns of recurrence and metastasis following pancreatic cancer (PC) resection. Methods: This is a retrospective case series study. Clinicopathological data and follow-up information were retrospectively collected from 210 patients who underwent surgery for PC at the Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, between January 2014 and December 2023. There were 114 males and 96 females; the age was (64.5±10.3) years (range: 29 to 89 years). Survival functions based on different times to recurrence and metastasis and different patterns of recurrence and metastasis were estimated using the Kaplan-Meier method, and survival differences among groups were compared using the Log-rank test. Identifying the optimal cutoff for time to postoperative recurrence/metastasis predicting overall survival (OS) in pancreatic cancer patients via the minimum p-value approach. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS following pancreatectomy. Results: A total of 210 patients met the inclusion and exclusion criteria. Among them, 71 patients remained free of recurrence and metastasis, while 139 developed recurrence and metastasis. The patterns included local recurrence (n=34), liver metastasis (n=39), lung metastasis (n=11), peritoneal metastasis (n=13), multiple sites metastasis (n=38), bone metastasis (n=3), and kidney metastasis (n=1). OS was significantly shorter in the group with postoperative recurrence and metastasis compared to the group without recurrence/metastasis (23.07 month vs.not reached, P<0.01). The optimal cut-off time distinguishing early from late recurrence and metastasis was 13 months. There was a significant difference in post-recurrence survival between patients with early and late recurrence and metastasis (16.03 month vs.52.40 month,P=0.009). The Kaplan-Meier survival curve showed that different postoperative recurrence and metastasis patterns had different impacts on OS, with lung metastasis showing the best prognosis compared to local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastasis (P<0.01). Multivariate Cox analysis revealed that Eastern Cooperative Oncology Group (ECOG) score 1, postoperative carcinoembryonic antigen (CEA)≥15 μg/L, poor tumor differentiation, postoperative local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastases are independent risk factors for postoperative recurrence and metastasis (all P<0.05). Conclusions: Considerable prognostic heterogeneity exists in postoperative PC patients depending on the site and pattern of recurrence or metastasis. Specifically, lung metastasis portends a significantly more favorable prognosis than liver metastasis, peritoneal metastasis, local recurrence, or multiple sites metastases. ECOG score 1, postoperative CEA≥15 μg/L, poor tumor differentiation, postoperative local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastases are independent risk factors for OS in postoperative PC patients.
目的： 探讨胰腺癌术后不同复发转移模式的预后差异及其影响因素。 方法： 本研究为回顾性病例系列研究。回顾性收集2014年1月至2023年12月于北京大学第一医院肝胆胰外科因胰腺癌行手术治疗的210例患者的临床病理学资料及随访信息。男性114例，女性96例；年龄为（64.5±10.3）岁（范围：29~89岁）。使用Kaplan-Meier法估计不同复发转移时间及不同复发转移模式下的生存函数，并通过Log-rank检验比较各组间的生存差异。使用最小P值法明确影响胰腺癌患者总体生存期的术后复发转移时间的最佳截断值。使用单因素及多因素Cox回归分析明确胰腺癌术后总体生存时间的独立影响因素。 结果： 210例患者中，71例术后未发生复发转移，139例术后出现复发转移，包括局部复发34例、肝转移39例、肺转移11例、腹膜转移13例、多器官转移38例、骨转移3例、肾转移1例。术后复发转移患者的总体生存时间短于无复发患者（23.07个月比未达到，P<0.01）。区别早期与晚期复发转移的最佳时间截断值为13个月，早、晚期复发转移患者复发后总体生存时间的差异有统计学意义（16.03个月比52.40个月，P=0.009）。Kaplan-Meier生存曲线显示，术后不同复发转移模式对总体生存时间的影响不同，其中肺转移患者的预后优于局部复发、肝转移、腹膜转移及多器官转移患者（P<0.01）。多因素Cox回归分析结果显示，东部肿瘤合作组（ECOG）评分1分、术后癌胚抗原≥15 μg/L、肿瘤分化程度低和术后局部复发、肝转移、腹膜转移及多器官转移是胰腺癌患者术后总体生存时间的独立不良预后因素（P值均<0.05）。 结论： 胰腺癌术后不同复发转移模式患者的预后存在显著差异，肺转移患者的预后优于肝转移、腹膜转移、局部复发及多器官转移患者。ECOG评分1分、术后癌胚抗原≥15 μg/L、肿瘤低分化和术后局部复发、肝转移、腹膜转移及多器官转移是胰腺癌患者术后总体生存的独立不良预后因素。.