By Lynda Williams, medwireNews Reporter
medwireNews: Research suggests that patients who are invited for routine imaging after pancreatic ductal adenocarcinoma (PDAC) resection have significantly longer overall survival (OS) than those who undergo imaging only after the development of symptoms.
Although routine surveillance is not recommended by current European guidelines, around two-thirds of the cohort participants were treated using this strategy and these patients were more likely to receive therapy for recurrent disease than those who were not, the study authors write in JAMA Surgery.
“These results suggest that the use of routine imaging in the postoperative follow-up of patients with PDAC was beneficial”, summarise Hjalmar van Santvoort (UMC Utrecht Cancer Center, the Netherlands) and co-workers.
Overall, 333 people who underwent PDAC resection between 2020 and 2021 at one of 33 centres affiliated with the European–African Hepato-Pancreato-Biliary Association were followed-up prospectively for 2 years after the last participant was recruited, giving a median duration of 40 months.
OS was a median 28 months for the 71% of patients who underwent routine imaging after surgery using computed tomography (92%), magnetic resonance imaging (6%) or positron emission tomography (2%) at a planned frequency, such as every 4–6 weeks or every 4–6 months.
This was significantly longer than the median OS of 23 months for the remaining 29% of patients who were not scheduled to receive routine imaging, the authors report.
PDAC recurrence was detected after a median 12 months in the routine imaging group versus 13 months in the symptomatic follow-up group, with median disease-free intervals of 12 and 6 months, respectively.
Patients who underwent routine imaging were significantly less likely to have symptoms at the time recurrence was diagnosed than those who did not receive routine screening (35 vs 85%) and, among the routine imaging group, median OS was longer for those with asymptomatic versus symptomatic recurrence (30 vs 21 months).
Moreover, participants who underwent routine imaging were significantly more likely to receive recurrence-focused treatments than those who did not (74 vs 48%), such as chemotherapy (54 vs 28%) or surgery (5 vs 0%).
The researchers acknowledge some differences at baseline between the patients who did and did not undergo routine imaging, such as median CA19-9 level at time of PDAC diagnosis (131 vs 308 U/mL), receipt of neoadjuvant (39 vs 26%) or adjuvant (66 vs 56%) therapy and the rate of successful R0 resection (55 vs 34%).
However, multivariable analysis indicated that receipt of routine imaging was associated with a significantly higher likelihood of receiving recurrence-focused therapy (odds ratio [OR]=2.57) and improved OS (OR for death=0.75) after adjusting for a raft of confounding factors, such as age, primary tumour location and size, number of positive lymph nodes and resection margin status.
Routine imaging was also associated with significantly better post-recurrence survival (OR=0.59) but not progression-free survival or the disease-free interval.
“We hypothesize that the group of patients with aggressive, fast progressing recurrences are anticipated to present with symptoms irrespective of the received follow-up approach, as these recurrences mostly rely on symptom manifestation that could also occur in between the follow-up intervals”, the researchers comment.
“Thus, routine diagnostics mainly advance the detection of biologically less aggressive, slowly progressing recurrences, that would otherwise become symptomatic at a later point in time.”
The team concludes: “These findings challenge existing international guidelines and support further research to establish optimal postoperative follow-up protocols for PDAC.”
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JAMA Surg 2024; doi:10.1001/jamasurg.2024.5024