Abstract
ObjectiveSome patients with pancreatic ductal adenocarcinoma (PDAC) are prone to rapid recurrence or metastasis after radical resection. However, evaluation methods for effectively identifying these patients are lacking. In this study, we established perioperative serum scoring systems to screen patients with early recurrence and poor prognosis.MethodsWe systematically analysed 44 perioperative serum parameters, including systemic inflammatory parameters, coagulation system parameters, tumor markers, and 18 clinicopathological characteristics of 218 patients with radical resection in our centre. Univariate Cox regression and LASSO regression models were used to screen variables. Kaplan-Meier survival analysis was used to compare relapse-free survival and overall survival. Multivariate Cox regression was used to evaluate the independent risk variables. AUC and C-index were used to reveal the effectiveness of the models. In addition, the effectiveness was also verified in an independent cohort of 109 patients.ResultsPreoperative systemic immune coagulation cascade (SICC) (including increased neutrophil to lymphocyte ratio, decreased lymphocyte to monocyte ratio, increased platelet and fibrinogen) and increased postoperative tumor markers (TMs) (CA199, CEA and CA242) were independent risk factors for early recurrence of resectable pancreatic cancer. On this basis, we established the preoperative SICC score and postoperative TMs score models. The patients with higher preoperative SICC or postoperative TMs score were more likely to have early relapse and worse prognosis. The nomogram based on preoperative SICC, postoperative TMs, CACI, smoking index, vascular cancer embolus and adjuvant chemotherapy can effectively evaluate the recurrence rate (AUC1 year: 0.763, AUC2 year: 0.679, AUC3 year: 0.657) and overall survival rate (AUC1 year: 0.770, AUC3 year: 0.804, AUC5 year: 0.763).ConclusionPreoperative SICC and postoperative TMs can help identify resectable PDAC patients with early recurrence and poor prognosis.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies with a 5-year survival rate of 10%, mainly caused by insidious rapid recurrence or metastasis [1]
The nomogram based on preoperative systemic immune coagulation cascade (SICC), postoperative tumor markers (TMs), Charson age comorbidity index (CACI), smoking index, vascular cancer embolus and adjuvant chemotherapy can effectively evaluate the recurrence rate (AUC1 year: 0.763, AUC2 year: 0.679, AUC3 year: 0.657) and overall survival rate (AUC1 year: 0.770, AUC3 year: 0.804, AUC5 year: 0.763)
We evaluated the comprehensive effects of pathological indexes, systemic inflammation indicators, coagulation system parameters, tumor markers and other serum parameters on the early recurrence and the prognosis of resectable PDAC during the perioperative period
Summary
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies with a 5-year survival rate of 10%, mainly caused by insidious rapid recurrence or metastasis [1]. About a quarter of these patients will rapidly relapse within 6 months after surgery, but may benefit from neoadjuvant chemotherapy [5,6,7]. Screening out these patients with high risk of early recurrence for precision medicine and early intervention could be an effective strategy to improve their prognosis and survival. There is no accessible evaluation system in clinic at present, driving us to establish new models for effective prediction of the early recurrence and overall survival (OS) of patients with resectable PDAC
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