Kwang Jun Ryu

Background/Objectives: Although local treatment has been increasingly applied to oligometastatic pancreatic ductal adenocarcinoma (PDAC), it remains unclear whether radiologically defined oligometastatic disease identifies patients who benefit from local treatment. We evaluated the survival impact of local treatment according to recurrence burden after curative resection of PDAC. Methods: We retrospectively reviewed patients who developed isolated liver or lung recurrence after curative-intent resection for PDAC between 2012 and 2021. Overall survival (OS) was compared according to metastatic organ, metastatic burden, and treatment strategy. Results: Among 269 patients (194 with liver and 75 with lung recurrences), those with lung recurrence, including those with oligometastatic disease, had significantly longer OS than those with liver recurrence. Although oligometastatic recurrence was associated with more favorable survival than multiple recurrences, no significant association between local treatment and longer OS was observed in either the liver or lung oligometastatic group in the conventional analysis. In patients with solitary lung recurrence, local treatment was associated with longer OS in the conventional analysis, but this association did not reach statistical significance in the time-dependent Cox analysis. Conclusions: Radiologically defined oligometastatic recurrence was associated with a favorable prognosis but was insufficient to identify patients likely to benefit from local treatment. Although an association between local treatment and longer survival was observed in patients with solitary lung recurrence, this finding was not statistically significant in the time-dependent Cox analysis and requires further validation.

Adrenal metastasis from hepatocellular carcinoma (HCC) is uncommon, and the role of surgical resection remains undefined. This study analyzed clinical outcomes and prognostic factors in patients who underwent adrenalectomy for adrenal metastasis from HCC at a single tertiary center. We retrospectively analyzed 31 patients who underwent adrenalectomy for adrenal metastasis from HCC (2002-2019), classified by initial HCC treatment: liver resection (n = 17), liver transplantation (n = 7), and non-surgical management (n = 7). The median age of patients was 58 years; 93.5% were male, and 90.3% had hepatitis B virus infection. The median interval from HCC diagnosis to adrenal metastasis was 20.5 months. After adrenalectomy, the median recurrence-free survival was 7.5 months, and the median overall survival (OS) was 34.3 months. The 5- and 10-year survival rates were 42.3% and 32.6%, respectively. OS differed significantly across treatment groups (p = 0.008): median OS was 75.5 months in the liver resection group, compared to 33.8 months in the non-surgical group and 20.7 months in the liver transplantation group. On multivariate Cox regression, prior liver resection was independently associated with reduced mortality. Adrenalectomy was associated with prolonged OS in selected patients with adrenal metastasis from HCC, particularly those with prior liver resection. Given the high recurrence rate and the lack of a non-surgical comparator, these findings warrant cautious interpretation. Adrenalectomy may be considered within a multidisciplinary framework for carefully selected patients, pending confirmation by prospective multicenter studies.

IntroductionAlthough pathologic complete response (pCR) after neoadjuvant therapy (NAT) is associated with favourable survival in pancreatic ductal adenocarcinoma (PDAC), factors predicting its achievement remain unclear. Furthermore, the clinical implications of pCR regarding definitive cure versus recurrence risk require further investigation.Materials and MethodsWe retrospectively analysed 181 patients with PDAC who underwent NAT followed by curative-intent resection between 2019 and 2024. Predictors of pCR were identified using multivariable logistic regression, the optimal NAT duration was determined using receiver operating characteristic curve analysis, and prognostic factors for survival were identified using Cox proportional hazards models.ResultsTwenty patients (11.0 per cent) achieved pCR. The optimal cut-off NAT duration for predicting pCR was nine cycles. In multivariable analysis, the independent predictors of pCR were chemoradiotherapy, pre-NAT carbohydrate antigen 19-9 (CA19-9) level of 37 U/mL or less, and post-NAT CA19-9 normalization. Patients achieving pCR demonstrated superior 2-year overall survival compared with those who did not achieve pCR. Receipt of nine or more NAT cycles was an independent prognostic factor for improved survival; however, 20 per cent of patients with pCR experienced recurrence.DiscussionIntensive NAT strategies, including chemoradiotherapy and extended duration of nine or more cycles, are associated with higher pCR rates and improved survival. Although pCR is a strong marker of favourable tumour biology, it does not guarantee cure, underscoring the need for risk-adapted surveillance.

Choo K, et al. Ann Surg Treat Res. 2026 Nov;111(5):270-279. https://doi.org/10.4174/astr.2026.111.5.270