Clinicopathological Analysis Of Recurrence And Metastasis Following Resection Of Pancreatic Adenocarcinoma

Objective:To investigate the clinical and pathological factors ofrecurrence and metastasis following resection of pancreaticadenocarcinoma and provide aid for decision of follow-up schedule andfurther treatment.Methods:A total of72patients who underwent resection for pancreaticadenocarcinoma from January2005to December2013were included in thecurrent study. Clinical and pathological data of patients were comparedbetween distant metastasis group and non-distant metastasis group.Univariate and logistic multivariate analyses were utilized to identifycorrelation factors of distant metastasis after operation.We utilizedreceiver operating characteristic (ROC) curve analysis and calculatedYouden index(sensitivity plus specificity then minus1) to evaluate thepredictive abilities of such correlation factors. Lymph node rate (LNR)and lymph node status (LNS) were underwent univariate analysis as well.Results: Liver metastasis is the most common site of72patients followingresection of pancreatic adenocarcinoma, followed by local recurrence.Univariate analysis revealed that the tumor size、TNM staging and lymphnode metastasis were correlated with distant metastases(P<0.05).Recurrence or metastasis time were similar between two groups(P>0.05).Multivariate analyses revealed that tumor size and lymph node metastasiswere independent risk factors of distant metastasis following resectionof pancreatic Adenocarcinoma. ROC curve analyses was employed to decidethe cut-off point of tumor size relating to distant metastases. Thus, wedemonstrated that tumor size>4.8cm and lymph node metastasissignificantly predict distant metastases after resection （sensitivity,90.9%; specificity,46.4%; area under the curve,0.758）. When applied to our sample,93.3%(14/15) of patients who met the indicators confirmedto develop distant metastasis after operation. Recurrence and metastasissites were similar between LNR≧0.2group and LNR<0.2group(P>0.05), butpatients with LNR≧0.2had shorter recurrence or metastasis time(P<0.05).For pancreatic head carcinoma patients with lymph nodes involvement,recurrence and metastasis sites were similar between the patients withonly first station LN metastasis and those with the second station LNmetastasis(P>0.05), but patients with the second station LN metastasishad shorter recurrence or metastasis time(P<0.05).Conclusions: Liver metastasis is the most common site following resectionof pancreatic Adenocarcinoma,and the recurrence or metastasis time doesnot correlated with the occurrence of distant metastasis.Tumor size andlymph node metastasis are independent risk factors of metastasisfollowing resection of pancreatic Adenocarcinoma.Tumor size>4.8cm andlymph node metastasis significantly predict distant metastases afteroperation.Patients with LNR≧0.2suffer from earlier recurrence ormetastasis.Patients with the second station LN involvement have shorterrecurrence or metastasis time in pancreatic head carcinoma.The number oflymph nodes involvement correlate with LNR and LNS.