Proposed preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after surgical resection: A multi-center retrospective study

Ippei Matsumoto, Yoshiaki Murakami, Makoto Shinzeki, Sadaki Asari, Tadahiro Goto, Masaji Tani, Fuyuhiko Motoi, Kenichiro Uemura, Masayuki Sho, Sohei Satoi, Goro Honda, Hiroki Yamaue, Michiaki Unno, Takahiro Akahori, A. Hon Kwon, Masanao Kurata, Tetsuo Ajiki, Takumi Fukumoto, Yonson Ku

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38 Citations (Scopus)

Abstract

Background/objective Although surgical resection remains the only chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC), postoperative early recurrence (ER) is frequently encountered. The purpose of this study is to determine the preoperative predictive factors for ER after upfront surgical resection. Methods Between 2001 and 2012, 968 patients who underwent upfront surgery with R0 or R1 resection for PDAC at seven high-volume centers in Japan were retrospectively reviewed. ER was defined as relapse within 6 months after surgery. Study analysis stratified by resectable (R) and borderline resectable (BR) PDACs was conducted according to the National Comprehensive Cancer Network guidelines. Results ER occurred in 239 patients (25%) with a median survival time (MST) of 8.8 months. Modified Glasgow prognostic score = 2 (odds ratio (OR) 2.06, 95% confidence interval (CI) 1.05-3.95; P = 0.044), preoperative CA19-9 ≥300 U/ml (OR 1.94, 1.29-2.90; P = 0.003), and tumor size ≥30 mm (OR 1.72, 1.16-2.56; P = 0.006), were identified as preoperative independent predictive risk factors for ER in patients with R-PDAC. In the R-PDAC patients, MST was 35.5, 26.3, and 15.9 months in patients with 0, 1 and ≥2 risk factors, respectively. There were significant differences in overall survival between the three groups (P < 0.001). No preoperative risk factors were identified in BR-PDAC patients with a high rate of ER (39%). Conclusions There is a high-risk subset for ER even in patients with R-PDAC and a simple risk scoring system is useful for prediction of ER.

Original languageEnglish
Pages (from-to)674-680
Number of pages7
JournalPancreatology
Volume15
Issue number6
DOIs
Publication statusPublished - 2015

Keywords

  • Early recurrence
  • Multi-center study
  • Pancreatic cancer
  • Pancreatic ductal adenocarcinoma
  • Preoperative risk factor
  • Resectable pancreatic cancer

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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