Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection
Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, and surgical resection is the only potentially curative approach. However, the rate of recurrence remains high, particularly within the first 6 months, and is associated with a poor prognosis. The present...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-08-01
|
| Series: | World Journal of Surgical Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12957-023-03141-3 |
| _version_ | 1827710713180717056 |
|---|---|
| author | Masaaki Murakawa Shinnosuke Kawahara Daishi Takahashi Yuto Kamioka Naoto Yamamoto Satoshi Kobayashi Makoto Ueno Manabu Morimoto Sho Sawazaki Hiroshi Tamagawa Takashi Ohshima Norio Yukawa Yasushi Rino Soichiro Morinaga |
| author_facet | Masaaki Murakawa Shinnosuke Kawahara Daishi Takahashi Yuto Kamioka Naoto Yamamoto Satoshi Kobayashi Makoto Ueno Manabu Morimoto Sho Sawazaki Hiroshi Tamagawa Takashi Ohshima Norio Yukawa Yasushi Rino Soichiro Morinaga |
| author_sort | Masaaki Murakawa |
| collection | DOAJ |
| description | Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, and surgical resection is the only potentially curative approach. However, the rate of recurrence remains high, particularly within the first 6 months, and is associated with a poor prognosis. The present study evaluated the clinical characteristics and risk factors for early recurrence in pancreatic ductal adenocarcinoma (PDAC) patients who underwent curative resection, regardless of the use of neoadjuvant chemotherapy, to identify predictive factors associated with early recurrence and poor outcomes as well as to determine the optimal treatment strategy for patients at high risk of early recurrence after surgical resection. Methods Patients who underwent pancreatic resection for PDAC at our institution from 2013 to 2021 were included in this study. We investigated the clinicopathological features of patients in groups: those with recurrence within 6 months, recurrence between 6 and 12 months, and recurrence beyond 12 months or no recurrence. A logistic regression analysis identified covariates associated with early recurrence at 6 and 12 months. Results The study included 403 patients with a median follow-up of 25.7 months. Recurrence was observed in 279 patients, with 14.6% recurring within 6 months, 23.3% within 6–12 months, and 62% after 12 months or not at all. The preoperative CA19-9 level, modified Glasgow prognostic score (mGPS), and positive peritoneal cytology were significant risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant risk factors for recurrence within 12 months. For patients who received preoperative chemotherapy or chemoradiotherapy, the preoperative CA19-9 level, mGPS, and positive peritoneal cytology were significant independent risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant independent risk factors for recurrence within 12 months. The study concluded that the overall survival after surgical resection for potentially resectable PDAC worsened according to the number of risk factors present in the patient. Conclusions We clarified that preoperative CA19-9, positive peritoneal cytology, and the lack of adjuvant chemotherapy were consistent predictors for early recurrence within 6 and 12 months. In addition, an increased number of risk factors affecting the patient was associated with a poorer overall survival after potentially curable resection. Calculating the number of risk factors for early recurrence may be an essential predictive factor when considering treatment strategies. |
| first_indexed | 2024-03-10T17:43:40Z |
| format | Article |
| id | doaj.art-48a0f29edf784ac79b8b72cad4bd7c87 |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-03-10T17:43:40Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-48a0f29edf784ac79b8b72cad4bd7c872023-11-20T09:37:04ZengBMCWorld Journal of Surgical Oncology1477-78192023-08-0121111110.1186/s12957-023-03141-3Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resectionMasaaki Murakawa0Shinnosuke Kawahara1Daishi Takahashi2Yuto Kamioka3Naoto Yamamoto4Satoshi Kobayashi5Makoto Ueno6Manabu Morimoto7Sho Sawazaki8Hiroshi Tamagawa9Takashi Ohshima10Norio Yukawa11Yasushi Rino12Soichiro Morinaga13Department of Gastrointestinal Surgery, Kanagawa Cancer CenterDepartment of Gastrointestinal Surgery, Kanagawa Cancer CenterDepartment of Gastrointestinal Surgery, Kanagawa Cancer CenterDepartment of Gastrointestinal Surgery, Kanagawa Cancer CenterDepartment of Gastrointestinal Surgery, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Surgery, Yokohama City University School of MedicineDepartment of Surgery, Yokohama City University School of MedicineDepartment of Gastrointestinal Surgery, Kanagawa Cancer CenterDepartment of Surgery, Yokohama City University School of MedicineDepartment of Surgery, Yokohama City University School of MedicineDepartment of Gastrointestinal Surgery, Kanagawa Cancer CenterAbstract Background Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, and surgical resection is the only potentially curative approach. However, the rate of recurrence remains high, particularly within the first 6 months, and is associated with a poor prognosis. The present study evaluated the clinical characteristics and risk factors for early recurrence in pancreatic ductal adenocarcinoma (PDAC) patients who underwent curative resection, regardless of the use of neoadjuvant chemotherapy, to identify predictive factors associated with early recurrence and poor outcomes as well as to determine the optimal treatment strategy for patients at high risk of early recurrence after surgical resection. Methods Patients who underwent pancreatic resection for PDAC at our institution from 2013 to 2021 were included in this study. We investigated the clinicopathological features of patients in groups: those with recurrence within 6 months, recurrence between 6 and 12 months, and recurrence beyond 12 months or no recurrence. A logistic regression analysis identified covariates associated with early recurrence at 6 and 12 months. Results The study included 403 patients with a median follow-up of 25.7 months. Recurrence was observed in 279 patients, with 14.6% recurring within 6 months, 23.3% within 6–12 months, and 62% after 12 months or not at all. The preoperative CA19-9 level, modified Glasgow prognostic score (mGPS), and positive peritoneal cytology were significant risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant risk factors for recurrence within 12 months. For patients who received preoperative chemotherapy or chemoradiotherapy, the preoperative CA19-9 level, mGPS, and positive peritoneal cytology were significant independent risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant independent risk factors for recurrence within 12 months. The study concluded that the overall survival after surgical resection for potentially resectable PDAC worsened according to the number of risk factors present in the patient. Conclusions We clarified that preoperative CA19-9, positive peritoneal cytology, and the lack of adjuvant chemotherapy were consistent predictors for early recurrence within 6 and 12 months. In addition, an increased number of risk factors affecting the patient was associated with a poorer overall survival after potentially curable resection. Calculating the number of risk factors for early recurrence may be an essential predictive factor when considering treatment strategies.https://doi.org/10.1186/s12957-023-03141-3Pancreatic ductal adenocarcinomaEarly recurrenceRisk factorsNeoadjuvant therapy |
| spellingShingle | Masaaki Murakawa Shinnosuke Kawahara Daishi Takahashi Yuto Kamioka Naoto Yamamoto Satoshi Kobayashi Makoto Ueno Manabu Morimoto Sho Sawazaki Hiroshi Tamagawa Takashi Ohshima Norio Yukawa Yasushi Rino Soichiro Morinaga Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection World Journal of Surgical Oncology Pancreatic ductal adenocarcinoma Early recurrence Risk factors Neoadjuvant therapy |
| title | Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection |
| title_full | Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection |
| title_fullStr | Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection |
| title_full_unstemmed | Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection |
| title_short | Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection |
| title_sort | risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection |
| topic | Pancreatic ductal adenocarcinoma Early recurrence Risk factors Neoadjuvant therapy |
| url | https://doi.org/10.1186/s12957-023-03141-3 |
| work_keys_str_mv | AT masaakimurakawa riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT shinnosukekawahara riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT daishitakahashi riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT yutokamioka riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT naotoyamamoto riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT satoshikobayashi riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT makotoueno riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT manabumorimoto riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT shosawazaki riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT hiroshitamagawa riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT takashiohshima riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT norioyukawa riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT yasushirino riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection AT soichiromorinaga riskfactorsforearlyrecurrenceinpatientswithpancreaticductaladenocarcinomawhounderwentcurativeresection |