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. 2019 Jun;269(6):1154-1162.
doi: 10.1097/SLA.0000000000002734.

Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma

Vincent P Groot  1   2 , Georgios Gemenetzis  1 , Alex B Blair  1 , Roberto J Rivero-Soto  1 , Jun Yu  1 , Ammar A Javed  1 , Richard A Burkhart  1 , Inne H M Borel Rinkes  2 , I Quintus Molenaar  2 , John L Cameron  1 , Matthew J Weiss  1 , Christopher L Wolfgang  1 , Jin He  1
Affiliations

Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma

Vincent P Groot et al. Ann Surg. 2019 Jun.

Abstract

Objectives: To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups.

Summary background data: A clear definition of "early recurrence" after pancreatic ductal adenocarcinoma resection is currently lacking.

Methods: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models.

Results: Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0 cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence.

Conclusion: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Different cut-off thresholds with corresponding P values show that the optimal threshold for defining early and late recurrence based on the difference of post-recurrence survival is 12 months.
FIGURE 2.
FIGURE 2.
The ROC curve for (A) preoperative CA 19–9 and (B) postoperative CA 19–9 for predicting early recurrence (<12 mo).
FIGURE 3.
FIGURE 3.
Kaplan–Meier curves showing worse recurrencefree survival for patients with elevated (A) preoperative and (B) postoperative CA 19–9 values.
See this image and copyright information in PMC

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