Pancreatic cancer: no benefit for intensified follow-up after curative resection

  • Wu H & al.
  • J Clin Med
  • 27 Jul 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Surveillance using regular imaging, tumor biomarkers, or both together was not associated with improved OS compared with history taking and physical examination (H&P; symptom based) evaluations after curative surgical resection of pancreatic cancer.

Why this matters

  • 2 US-based guidelines recommend intensified surveillance, whereas 3 European guidelines recommend against because of a lack of evidence that it prolongs survival.

Study design

  • Retrospective, single-center analysis of recurrent or metastatic pancreatic cancer (n=181).
  • Groups included H&P only, H&P+imaging, H&P+biomarker, and H&P+imaging+biomarker.
  • Funding: Taiwan government.

Key results

  • Median OS (P=.670):
    • H&P only: 21.4 months.
    • H&P/imaging: 13.9 months.
    • H&P/biomarker: 20.5 months.
    • H&P/imaging+biomarker: 16.5 months.
  • Median relapse-free survival (P=.259):
    • H&P only: 11.7 months.
    • H&P/imaging: 6.3 months.
    • H&P/biomarker: 9.3 months.
    • H&P/imaging+biomarker: 6.9 months.
  • Median postrecurrence OS (P=.953):
    • H&P only: 6.9 months.
    • H&P/imaging: 7.5 months.
    • H&P/biomarker: 5.0 months.
    • H&P/imaging+biomarker: 7.8 months.
  • Risk factors affecting OS:
    • Eastern Cooperative Oncology Group Performance Status (0 vs ≥1; HR, 0.516; P=.020).
    • Primary tumor site: head/body vs tail; HR, 0.599; P=.049.
    • Tumor grade: good/moderate vs poor differentiation; HR, 0.553; P=.032.

Limitations

  • Taiwanese population.
  • Retrospective.