title: Pattern of first recurrent lesions in pancreatic cancer: hepatic relapse is associated with dismal prognosis and portal vein invasion.
abstract: OBJECTIVE
  The aim of this study was to evaluate patterns of the initial recurrence after pancreatectomy for pancreatic cancer and risk factors in each pattern.
  
  
  METHODS
  This study included 209 pancreatic cancer patients who underwent pancreatectomy and of whom the detailed information on the first recurrent lesions detected by imaging during postoperative followup were available. Relapse patterns were classified into 4 groups: liver, peritoneal, local and extra-abdominal recurrences. We evaluated their associations with prognosis and various clinicopathological factors to identify relevant risk factors.
  
  
  RESULTS
  Cumulative numbers of patients with liver, peritoneal, local, and extra-abdominal recurrences were 81, 70, 98 and 22, respectively, for the first recurrences. Hepatic relapse was associated with significantly shorter overall survival than other sites (p<0.001) and was an independent prognostic factor in multivariate analysis (p<0.001). Pathological portal vein invasion was the only independent risk factor for hepatic relapse (p=0.045). There was no significant correlation between the depth of invasion and prevalence of hepatic relapse.
  
  
  CONCLUSIONS
  Hepatic relapse was associated with a dismal prognosis and with pathological portal vein invasion. Novel therapeutic strategies are therefore required to reduce the incidence of hepatic relapse, especially in patients with portal vein invasion.
authors.forename: Masaya
authors.initials: M
authors.lastname: Suenaga
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.forename: Hideki
authors.initials: H
authors.lastname: Takami
authors.forename: Norio
authors.initials: N
authors.lastname: Okumura
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Inokawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.forename: Chie
authors.initials: C
authors.lastname: Tanaka
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000556:secondary* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome