Preoperative predictors for early recurrence of resectable pancreatic cancer

Kohei Nishio,Kenjiro Kimura,Go Ohrira,Sadaaki Yamazoe,Kosei Hirakawa,Masaichi Ohira,Ryosuke Amano,Bunzo Nakata

doi:10.1186/s12957-016-1078-z

Abstract

BackgroundThe first-line treatment for resectable pancreatic cancer (RPC) is surgical resection. However, our patients have often experienced early recurrence after curative resection for RPC, with desperately poor prognosis. Some reports indicated that minimally distant metastasis not detected at operation might cause early recurrence. The present study aimed to identify preoperative clinicopathological features of early recurrence after curative resection of RPC.MethodsNinety RPC patients who underwent curative resection between 2000 and 2014 at our institution were retrospectively analyzed.ResultsOf the 90 patients, 32 had recurrence within 1 year. Univariate analysis demonstrated that preoperative serum carbohydrate antigen (CA19-9) ≥529 U/mL (P = 0.0011), preoperative serum s-pancreas-1 antigen (SPan-1) ≥37 U/mL (P = 0.0038), and histological grades G2–G4 (P = 0.0158) were significantly associated with recurrence within 1 year after curative resection. Multivariate analysis demonstrated that preoperative serum CA19-9 ≥ 529 U/mL (P = 0.0477) and histological grade G2–G4 (P = 0.0129) were independent predictors of recurrence within 1 year. Recurrent cases within 1 year postoperatively had significantly more distant metastasis than cases with no recurrence within 1 year (P < 0.001).ConclusionsPreoperative serum CA19-9 ≥ 529 U/mL and histological grades G2–G4 were independent predictive factors for recurrence within 1 year after pancreatectomy for RPC. Furthermore, recurrent cases within 1 year had more frequent distant metastasis than cases with no recurrence within 1 year. These results suggest that RPC patients with preoperative serum CA19-9 ≥ 529 U/mL should receive preoperative therapy rather than surgery.

Highlights

The first-line treatment for resectable pancreatic cancer (RPC) is surgical resection
A receiver operating characteristic (ROC) curve demonstrated that preoperative serum Carbohydrate antigen 19-9 (CA19-9) level of 529 U/mL was the optimal cutoff point for recurrence within 1 year after surgery, with sensitivity of 86.2% and specificity of 50%
Recurrence patterns and prognosis of the patients stratified by preoperative serum CA19-9 level and tumor diameter we focused on tumor diameter and preoperative serum CA19-9 level

Summary

Introduction

The first-line treatment for resectable pancreatic cancer (RPC) is surgical resection. Our patients have often experienced early recurrence after curative resection for RPC, with desperately poor prognosis. The present study aimed to identify preoperative clinicopathological features of early recurrence after curative resection of RPC. Patients with pancreatic cancer have been reported to have a 5-year overall survival (OS) of approximately 5% [1]. 20% of patients with pancreatic cancer are candidates for potentially radical resection [2]. Preoperative predictors of survival time after surgery have been reported as tumor size [3], some studies have suggested that minimally distant metastasis undetectable even by recent advanced diagnostic imaging might have existed at the time of surgery in patients with early recurrence [7, 8]. Occult peritoneal or liver metastatic disease has been reported to be missed by CT in 4 to 15% of patients [3]

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