Abstract
Simple SummaryMost patients with a pancreatic ductal adenocarcinoma develop a recurrence after surgery. Predictive factors may therefore guide therapeutic decision-making. We aimed to identify perioperative predictors of the early recurrence of pancreatic ductal adenocarcinomas. We found that preoperative (>52 U/mL) and postoperative (>37 U/mL) elevated carbohydrate antigen 19-9 levels as well as a tumor size >3.0 cm were independently associated with an early recurrence after a pancreatectomy. Furthermore, an early recurrence resulted in a more frequent liver metastasis than a late recurrence, suggesting that patients experiencing a recurrence within 12 months had undetectable micrometastases. Further studies are needed to identify new biomarkers for the detection of clinically occult micrometastases during surgery as current preoperative risk factors are inadequate to accurately identify patients susceptible to an early recurrence of pancreatic ductal adenocarcinomas.We aimed to identify the perioperative predictors of the early recurrence (ER) of resectable and borderline-resectable pancreatic ductal adenocarcinomas (PDACs). After surgery for a PDAC, most patients develop a recurrence. Predictive factors may therefore guide therapeutic decision-making. Patients (n = 234) who underwent a pancreatectomy for a PDAC between 2006 and 2019 were included. The postrecurrence survival (PRS) was estimated using Kaplan–Meier curves. Predictive factors for an ER were assessed using logistic regression analyses; 93 patients (39.7%) were recurrence-free at the last follow-up. Patients with an ER (n = 85, 36.3%), defined as a recurrence within the first 12 months after surgery, had 1- and 2-year PRS rates of 38.7% and 9.5%, respectively, compared with 66.9% and 37.2% for those with a late recurrence (n = 56, 23.9%; both p < 0.001). The most common site of an ER was the liver (55.3%) with a significantly shorter median overall survival time than that with either a local or a lung recurrence (14.5 months; p < 0.001). Preoperative and postoperative risk factors for an ER included a tumor size >3.0 cm (odds ratio (OR): 3.11, 95% confidence interval (CI): 1.35–7.14) and preoperative carbohydrate antigen 19-9 (CA19-9) levels >52 U/mL (OR: 3.25, 95% CI: 1.67–6.30) and a pathological tumor size >3.0 cm (OR: 2.00, 95% CI: 1.03–3.90) and postoperative carbohydrate antigen 19-9 levels >37 U/mL (OR: 2.11, 95% CI: 1.02–4.36), respectively. Preoperatively (>52 U/mL) and postoperatively (>37 U/mL) elevated CA19-9 and a tumor size >3.0 cm were independent predictors for an ER after a pancreatectomy for a PDAC.
Highlights
A pancreatic ductal adenocarcinoma (PDAC), one of the most aggressive cancers worldwide, is predicted to become the second leading cause of cancer-related deaths in Western countries within the 10 years [1]
No significant differences were observed among the R status groups with respect to sex, the American Society of Anesthesiologist physical status (ASA PS) classification system, the body mass index (BMI), the surgical procedure, vascular resection, the histological type or the T-stage
A receiver operating characteristic (ROC) curve demonstrated that a preoperative serum carbohydrate antigen 19-9 (CA19-9) value of 52 U/mL was the optimal cut-off point for an early recurrence (ER) after surgery with a sensitivity and specificity of 72.5% and 55.5%, respectively; the area under the ROC curve (AUC) was 0.6630
Summary
A pancreatic ductal adenocarcinoma (PDAC), one of the most aggressive cancers worldwide, is predicted to become the second leading cause of cancer-related deaths in Western countries within the 10 years [1]. In Japan, a PDAC is the fourth leading cause of cancer-related deaths; the number of patients is predicted to increase in the future [2]. The criteria for resectability have been proposed by the National Comprehensive Cancer Network (NCCN) [3]. Recommended therapeutic strategies are applied according to this classification to improve prognosis; even in cases classified as resectable according to the NCCN guidelines, a low postoperative survival rate has been reported [4,5]. Approximately 80% of patients experience local and metastatic recurrence, with >50% occurring within the first 12 months after curative surgery [6]
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