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. 2017 Jan 10;15(1):16.
doi: 10.1186/s12957-016-1078-z.

Preoperative predictors for early recurrence of resectable pancreatic cancer

Kohei Nishio  1 , Kenjiro Kimura  2 , Ryosuke Amano  1 , Sadaaki Yamazoe  1 , Go Ohrira  1 , Bunzo Nakata  3 , Kosei Hirakawa  1 , Masaichi Ohira  1
Affiliations

Preoperative predictors for early recurrence of resectable pancreatic cancer

Kohei Nishio et al. World J Surg Oncol. .

Abstract

Background: The 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.

Methods: Ninety RPC patients who underwent curative resection between 2000 and 2014 at our institution were retrospectively analyzed.

Results: Of 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).

Conclusions: Preoperative 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.

Keywords: CA19-9; Histological grade; Preoperative predictors; Resectable pancreatic cancer; Tumor diameter.

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Figures

Fig. 1
Fig. 1
Survival curve of each independent risk factor. The median overall survival (OS) was 23.1 months in patients with CA19-9 ≥ 529 U/mL, compared to 55.9 months in patients with CA19-9 < 529 U/mL, with a significant difference between the groups (P = 0.0038) (a). The median OS was 37.5 months in patients with histological grades G2–G4, compared to 64.6 months in patients with G1, with no significant difference (P = 0.0648) (b)
Fig. 2
Fig. 2
Disease-free survival of each independent risk factor. The median disease-free survival (DFS) was 8.4 months in patients with CA19-9 ≥ 529 U/mL, compared to 27.1 months in patients with CA19-9 < 529 U/mL, with a significant difference between the groups (P = 0.0008) (a). The median DFS was 16.1 months in patients with histological grades G2-G4, compared to 51.5 months in patients with G1, with no significant difference (P = 0.2197) (b)
Fig. 3
Fig. 3
Survival curve of three groups stratified for preoperative serum CA19-9 level. The median OS in group A did not reach the median time, the median OS in group B was 40.5 months, and the median OS in group C was 23.1 months. The survival times were not statistically significantly different between the three groups, but stratified Kaplan-Meier curves could be drawn for these divided groups
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