Surgical endoscopy · 2026
Spatiotemporal heterogeneity of recurrence and predictors after radical surgery for pancreatic ductal adenocarcinoma: a retrospective observational study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Wang Rui, Kuang Tianrui, Long You, Huang Yuanbin, Sun Yunwei, Tian Yugui, Ding Junjie, Gao Pan, Cai He, Li Yongbin, Wang Xin, Cai Yunqiang, Zhou Jin, Peng Bing, Wu Zhong
Аннотация
BACKGROUND: Postoperative recurrence severely limits long-term survival after radical resection for pancreatic ductal adenocarcinoma (PDAC), yet the spatiotemporal heterogeneity and determinants of recurrence remain incompletely understood.
METHODS: We conducted a single-center retrospective study of PDAC patients who underwent radical surgery at our institution between 2014 and 2024. Regression analyses were used to identify factors associated with temporal (early [≤ 1 year] vs. late [> 1 year] recurrence) and spatial (site of initial recurrence) heterogeneity.
RESULTS: Among 1,065 enrolled patients, 879 experienced recurrences, with cumulative recurrence rates of 55.7, 76.6, and 92.3% at 1, 2, and 5 years, respectively. Early recurrence occurred in 593 patients and late recurrence in 286. Initial recurrence patterns included local (22.4%), liver (52.3%), lung (5.8%), peritoneal (12.7%), and mixed/other metastases (6.7%). Male, poor tumor differentiation, advanced pathological stage, and lack of adjuvant therapy were independent factors for early recurrence. Liver and peritoneal metastases were independently associated with early recurrence and shorter recurrence-free survival (RFS), whereas lung metastasis correlated with later recurrence and longer RFS. Key factors influencing RFS varied by recurrence site: for local recurrence-poor differentiation, nodal metastasis, and no adjuvant therapy; for liver metastasis-larger tumor size, poor differentiation, nodal metastasis, and no adjuvant therapy; for lung metastasis-larger tumor size and nodal metastasis; for peritoneal metastasis-larger tumor size, surgical procedure, nodal metastasis, and no adjuvant therapy.
CONCLUSIONS: Postoperative recurrence in PDAC demonstrates significant spatiotemporal heterogeneity, with timing-specific and site-specific risk factors. These findings support tailored follow-up strategies and refined risk assessment for recurrent PDAC.
METHODS: We conducted a single-center retrospective study of PDAC patients who underwent radical surgery at our institution between 2014 and 2024. Regression analyses were used to identify factors associated with temporal (early [≤ 1 year] vs. late [> 1 year] recurrence) and spatial (site of initial recurrence) heterogeneity.
RESULTS: Among 1,065 enrolled patients, 879 experienced recurrences, with cumulative recurrence rates of 55.7, 76.6, and 92.3% at 1, 2, and 5 years, respectively. Early recurrence occurred in 593 patients and late recurrence in 286. Initial recurrence patterns included local (22.4%), liver (52.3%), lung (5.8%), peritoneal (12.7%), and mixed/other metastases (6.7%). Male, poor tumor differentiation, advanced pathological stage, and lack of adjuvant therapy were independent factors for early recurrence. Liver and peritoneal metastases were independently associated with early recurrence and shorter recurrence-free survival (RFS), whereas lung metastasis correlated with later recurrence and longer RFS. Key factors influencing RFS varied by recurrence site: for local recurrence-poor differentiation, nodal metastasis, and no adjuvant therapy; for liver metastasis-larger tumor size, poor differentiation, nodal metastasis, and no adjuvant therapy; for lung metastasis-larger tumor size and nodal metastasis; for peritoneal metastasis-larger tumor size, surgical procedure, nodal metastasis, and no adjuvant therapy.
CONCLUSIONS: Postoperative recurrence in PDAC demonstrates significant spatiotemporal heterogeneity, with timing-specific and site-specific risk factors. These findings support tailored follow-up strategies and refined risk assessment for recurrent PDAC.