Importance International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide. Objective To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA). Design, Setting, and Participants This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging. Exposures Symptomatic follow-up or routine imaging in patients who underwent PDAC resection. Main Outcomes and Measures Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS. Results Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04). Conclusion and Relevance In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

中文翻译：

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胰腺癌切除术后的常规影像学检查或症状随访。


重要性 国际指南对胰腺导管腺癌 （PDAC） 胰腺切除术后随访中常规影像学检查的建议缺乏一致性。因此，全球各中心的随访策略不同。目的 比较在欧洲-非洲肝胰胆协会 （E-AHPBA） 附属国际中心接受胰腺切除术后症状随访或常规影像学检查的 PDAC 复发患者的临床结局，包括以复发为重点的治疗和生存率。设计、设置和参与者 这是一项前瞻性、国际性的横断面研究。2020 年至 2021 年期间，来自来自 13 个国家的共 33 个 E-AHPBA 中心的患者被纳入。根据预定义的研究方案，前瞻性纳入接受 PDAC 切除术并被诊断为疾病复发的患者。根据术后随访策略对患者进行分层： 症状性随访 （即无常规影像学检查） 或常规影像学检查。暴露 接受 PDAC 切除术的患者的症状随访或常规影像学检查。主要结局和测量 总生存期 （OS） 用 Kaplan-Meier 曲线估计，并使用对数秩检验进行比较。为了调整潜在的混杂因素，使用多变量 logistic 回归来评估随访策略与以复发为中心的治疗之间的关联。采用多变量 Cox 比例风险分析研究随访策略与 OS 之间的独立关联。结果 共纳入 333 例 PDAC 复发患者 （平均 [SD] 年龄，65 [11] 岁;184 例男性 [55%]）。 纳入最后一名患者后 2 年分析时的中位 （IQR） 随访时间为 40 （30-58） 个月。在整个队列中，98 例患者 （29%） 接受了症状随访，235 例患者 （71%） 接受了常规影像学检查。接受症状随访组与常规影像学检查组的 OS 分别为 23 个月 （95% CI，19-29 个月） 和 28 个月 （95% CI，24-30 个月） （P = .01）。常规影像学检查与接受以复发为中心的治疗相关 （校正比值比，2.57;95% CI，1.22-5.41;P = .01） 和延长的 OS （校正风险比，0.75;95% CI，0.56-.99;P = .04）。结论和相关性 在这项国际前瞻性横断面研究中，PDAC 胰腺切除术后的常规随访影像学检查与接受复发聚焦治疗和延长 OS 独立相关。