Abstract
This study aimed to identify predictors for early and very early disease recurrence in patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) resection with and without neoadjuvant therapy. Included were patients who underwent PDAC resection (2014-2016). Multivariable multinomial regression was performed to identify preoperative predictors for manifestation of recurrence within 3, 6 and 12 months after PDAC resection. 836 patients with a median follow-up of 37 (interquartile range [IQR] 30-48) months and overall survival of 18 (IQR 10-32) months were analyzed. 670 patients (80%) developed recurrence: 82 patients (10%) <3 months, 96 patients (11%) within 3-6 months and 226 patients (27%) within 6-12 months. LogCA 19-9 (OR 1.25 [95% CI 1.10-1.41]; P<0.001) and neoadjuvant treatment (OR 0.09 [95% CI 0.01-0.68]; P=0.02) were associated with recurrence <3 months. LogCA 19-9 (OR 1.23 [95% CI 1.10-1.38]; P<0.001) and 0-90° venous involvement on CT imaging (OR 2.93 [95% CI 1.60-5.37]; P<0.001) were associated with recurrence within 3-6 months. A Charlson Age Comorbidity Index ≥4 (OR 1.53 [95% CI 1.09-2.16]; P=0.02) and logCA 19-9 (OR 1.24 [95% CI 1.14-1.35]; P<0.001) were related to recurrence within 6-12 months. This study demonstrates preoperative predictors that are associated with the manifestation of early and very early recurrence after PDAC resection. Knowledge of these predictors can be used to guide individualized surveillance and treatment strategies.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is the most lethal digestive cancer with a 5-year survival of 12–17% after resection.[1,2,3] Despite recent advancements in pancreatic ductal adenocarcinoma (PDAC) detection, systemic therapy and surgical techniques, survival rates have only slightly improved over the last decade.[1,4,5] For patients with nonmetastasized, borderline resectable or resectable PDAC, radical resection combined with chemotherapy offers the best chance for long-term survival
This study shows preoperative predictors for the manifestation of early and very early disease recurrence after PDAC resection using data from a nationwide, unselected cohort of patients
0–90 venous tumor involvement on preoperative CT imaging, and a Charlson Age-Comorbidity Index (CACI) score 4 were associated with the manifestation of disease recurrence within 3 months, 3–6 months and 6–12 months, respectively
Summary
Pancreatic ductal adenocarcinoma (PDAC) is the most lethal digestive cancer with a 5-year survival of 12–17% after resection.[1,2,3] Despite recent advancements in PDAC detection, systemic therapy and surgical techniques, survival rates have only slightly improved over the last decade.[1,4,5] For patients with nonmetastasized, borderline resectable or resectable PDAC, radical resection combined with chemotherapy offers the best chance for long-term survival. Knowledge on preoperative predictors for early and very early disease recurrence after PDAC resection could support shared-decision making regarding upfront resection or neoadjuvant treatment strategies. This study aimed to identify predictors for early and very early disease recurrence in patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) resection with and without neoadjuvant therapy. Multivariable multinomial regression was performed to identify preoperative predictors for manifestation of recurrence within 3, 6 and 12 months after PDAC resection. Conclusion: This study demonstrates preoperative predictors that are associated with the manifestation of early and very early recurrence after PDAC resection. Knowledge of these predictors can be used to guide individualized surveillance and treatment strategies
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