ACTIVE FOLLOW-UP OF PANCREATIC ADENOCARCINOMA: THE IMPACT ON DIAGNOSING RELAPSE AND OVERALL SURVIVAL

Introduction: Pancreatic cancer has a poor prognosis, even in patients with localized disease undergoing curative treatment. It is estimated that only 20% of these patients will be alive in 5 years. Most of them will relapse within the first 2 years, with a median overall survival of 3-7 months. Although follow-up with imaging and tumor marker is a procedure based on expert opinion, early diagnosis of recurrence, especially in asymptomatic patients, has been associated with increase overall survival. Objective: Describe the follow-up pattern, the clinical and laboratory characteristics of relapse and the post- recurrence treatments performed by patients with pancreatic adenocarcinoma undergoing curative treatment. Furthermore, to compare the overall survival of asymptomatic and symptomatic patients who relapsed. Methods: Retrospective analytical single-center cohort study conducted through a survey of medical records of patients with pancreatic tumors undergoing follow-up in the period from January 2008 to December 2018. Results: 73 patients were included. The median age was 64 years, lesions predominantly in the head and neck (75,3%). At diagnosis, 67.1% had resectable disease, 13.7% were N+, and the median pre-operative CA 19-9 level was 83 U/ml. A total of 537 segment imaging exams were performed, mainly computed tomography (n=395), with an average interval of 3.3 months between scans in the first two years. During follow-up 48 patients had disease recurrence – 56% with metastatic disease. The main sites were liver and peritoneum (29.2% and 25%, respectively). At recurrence, 56.3% had ECOG 1 and 64.3% had CA 19-9 elevation. Among relapsed patients, 73.8% had symptoms such as diarrhea and abdominal distension. Palliative chemotherapy with FOLFIRINOX was the main systemic treatment performed after relapse. The overall survival after relapse of asymptomatic and symptomatic patients were 25.4 and 11.3 months, respectively (p 0.015).