Predictors of distant metastasis on exploration in patients with potentially resectable pancreatic cancer

Xinchun Liu, Yue Fu, Qiuyang Chen, Junli Wu, Wentao Gao, Kuirong Jiang, Yi Miao, Jishu Wei, Xinchun Liu, Yue Fu, Qiuyang Chen, Junli Wu, Wentao Gao, Kuirong Jiang, Yi Miao, Jishu Wei

Abstract

Background: Patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC) are frequently found to be unresectable on exploration due to small distant metastasis. This study was to investigate predictors of small distant metastasis in patients with potentially resectable PDAC.

Methods: Patients who underwent surgical exploration for potentially resectable PDAC from 2013 to 2014 were reviewed retrospectively and divided into two groups according to whether distant metastases were encountered on exploration. Then, univariate and multivariate logistic regression analyses were used to identify predictors of distant metastasis. A scoring system to predict distant metastasis of PDAC on exploration was constructed based on the regression coefficient of a multivariate logistic regression model.

Results: A total of 235 patients were included in this study. Mean age of the study population was 61.7 ± 10.4 years old. Upon exploration, distant metastases were found intraoperatively in 62 (26.4%) patients, while the remaining 173 were free of distant metastases. Multivariate logistic regression analysis identified that age ≤ 62 years old (p < 0.001), male sex (p = 0.011), tumor size ≥4.0 cm (p < 0.001), alanine aminotransferase level (ALT) < 125 U/L (p < 0.001), and carbohydrate antigen (CA19-9) level ≥ 385 U/mL (p < 0.001) were independent risk factors for occult distant metastasis of PDAC. A preoperative scoring system (0-8 points) for distant metastasis on exploration was constructed using these five factors. The receiver operating characteristic curves showed that the area under the curve of this score was 0.85. A score of 6 points was suggested to be the optimal cut-off value, and the sensitivity and specificity were 85% and 69%, respectively.

Conclusions: Distant metastasis is still frequently encountered on exploration for patients with potentially resectable PDAC. Younger age, male sex, larger tumor size, low ALT level and high CA19-9 level are independent predictors of unexpected distant metastasis on exploration.

Keywords: Distant metastasis; Pancreatic cancer; Predictive factor; Surgical exploration.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review board at The First Affiliated Hospital of Nanjing Medical University (No. 2016-SR-210). Due to the retrospective nature of this study and all data was retrieved from medical records without additional blood samples or biochemical analysis, informed consent from individual participants was waived.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram showing selection of patients for inclusion in the study
Fig. 2
Fig. 2
Prediction of distant metastasis. a Proportion of patients with occult metastasis during laparotomy. b Receiver operating characteristics of number of factors to predict the risk for distant metastasis found at operation

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