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Local treatment of pancreatic cancer metastases: A multicenter French study of the AGEO group - 11/11/21

Doi : 10.1016/j.clinre.2020.101607 
Clémence Breton a, 1, , Antoine Meyer a, 1, David Malka b, Margarida Matias b, Thierry De Baere c, Pascal Hammel d, Antonio Sa Cunha e, Angelica Lucchese e, David Fuks f, Romain Coriat g, Claire Gallois h, Yann Touchefeu i, Marianne Maillet j, Isabelle Trouilloud k, Pierre Rompteaux l, Franck Carbonnel a, Emilie Soularue m
a Department of Gastroenterology, Bicêtre Hospital AP-HP, Paris-Saclay University, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France 
b Department of Medical Oncology, Gustave Roussy, Paris-Saclay University, 114 Rue Edouard Vaillant, 94800 Villejuif, France 
c Department of Radiology, Gustave Roussy, Paris-Saclay University, 114 Rue Edouard Vaillant, 94800 Villejuif, France 
d Department of Oncology, Beaujon Hospital AP-HP, Paris University, 100 Boulevard du Général Leclerc, 92110 Clichy, France 
e Department of Digestive Surgery, Hepatobiliary Center of Paul Brousse APHP, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France 
f Department of Digestive Surgery, Institute Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France 
g Department of Gastro-enterology, Cochin Hospital AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France 
h Department of Hepato-Gastroenterology and Gastrointestinal Oncology, European Georges Pompidou Hospital AP-HP, Paris University, 20 Rue Leblanc, 75015 Paris, France 
i Department of Gastroenterology, Nantes University Hospital, 5 Allée de L'île Gloriette, 44000 Nantes, France 
j Department of Gastroenterology, Saint-Louis Hospital AP-HP, Paris University,1 Avenue Claude Vellefaux, 75010 Paris, France 
k Department of Medical Oncology, Saint-Antoine Hospital AP-HP, Sorbonne University, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France 
l Department of Gastroenterology, Avicenne Hospital AP-HP, Sorbonne University, 125 Rue de Stalingrad, 93000 Bobigny, Paris, France 
m Department of Oncology, Institute Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France 

Corresponding author.

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Highlights

In highly selected patients, local treatment of metastases from PDAC is associated with prolonged survival.
Factors associated with shorter OS were liver metastases, N2 status and synchronous metastases.
The rate of severe complications was low.

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Abstract

Objective

This study reports the efficacy and safety of local treatment of metastases of pancreatic ductal adenocarcinoma (PDAC), with a curative intent.

Methods

We retrospectively included patients with histologically proven PDAC, who underwent a local treatment for metastases between January 1, 2000 and December 31, 2017, from 11 French hospitals. Complications of local treatment were reported. Univariate Cox models were performed to identify prognosis factors associated with overall survival (OS) and disease-free survival (DFS).

Results

We included 52 patients treated for 68 metastases; 33 (64%) of whom had metachronous metastases. Metastatic sites treated were: 39 (57%) hepatic, 18 (27%) pulmonary and 11 (16%) others. Metastases treatments were: 45 (66%) surgery, 9 (13%) radiofrequency and 14 (21%) other procedures. The rates of severe complications and mortality were respectively 10% and 4%. The median OS and DFS after local treatment were 36.5 months and 12.7 months, respectively. Prognosis factors associated with a shorter OS were: liver metastases when compared with lung metastases (HR 4.04; 95%CI: 1.18−13.81), N2 status of primary pancreatic tumor when compared to N0–N1 (HR 9.43; 95%CI: 2.44−36.36) and synchronous metastases when compared to metachronous metastases (HR 2.34; 95%CI: 1.05−5.23). N2 status of primary pancreatic tumor was associated with a shorter DFS when compared to N0-N1 (HR 2.82; 95%CI: 1.05–7.58).

Conclusion

In this series of highly selected patients, local treatment of metastases from PDAC is associated with prolonged survival. The rate of severe complications was low. Factors associated with shorter OS were liver metastases, N2 status and synchronous metastases.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Local treatment, Pancreatic cancer, Metastases, Curative intent, Surgery, Radiotherapy


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