Pancreatic Cancer with Liver Oligometastases—Different Patterns of Disease Progression May Suggest Benefits of Surgical Resection

TL;DR

Some pancreatic cancer patients with limited liver metastases may benefit from surgery, as they can die from local tumor issues without widespread spread.

Contribution

The study identifies a subset of pancreatic cancer patients with liver oligometastases who may benefit from surgical resection based on patterns of disease progression.

Findings

Patients with liver oligometastases had better overall survival than those with high-burden disease.

About 22% of patients died from local tumor complications, some without metastatic progression.

Smoking history was the only significant predictor of death from local complications.

Abstract

Background: Pancreatic adenocarcinoma (PDAC) with liver oligometastases (LOM) presents a therapeutic challenge, with optimal management strategies remaining uncertain. This study evaluates the long-term outcomes, patterns of disease progression, and potential factors influencing prognosis in this patient subset. Methods: Patients diagnosed with PDAC and LOM were retrospectively analyzed. Disease progression patterns, causes of death, and predictors of long-term outcomes were assessed. Results: Among 1442 patients diagnosed with metastatic PDAC between November 2009 and July 2024, 129 (9%) presented with LOM, defined as ≤3 liver lesions each measuring <2 cm. Patients with LOM had significantly improved overall survival (OS) compared to those with high-burden disease (p = 0.026). The cause of death (local regional disease vs. systemic disease) could be determined in 74 patients (57%), among whom age at diagnosis, history of smoking, and white blood cell (WBC) count differed significantly between groups. However, no significant difference in OS was observed between the two groups (p = 0.64). Sixteen patients (22%) died from local complications of the primary tumor, including 6 patients (7%) who showed no evidence of new or progressive metastases. In competing risk and multivariable analysis, a history of smoking remained the only factor significantly associated with death due to local complications. Conclusions: Approximately one in five patients with PDAC-LOM died from local tumor-related complications—some without metastatic progression—highlighting a potential role for surgical intervention. Further multicenter studies are warranted to refine diagnostic criteria and better identify patients who may benefit from surgery.

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