Resected PDAC: study identifies optimal cutoff for early vs late recurrence

  • Groot VP & al.
  • Ann Surg
  • 01.06.2019

  • von Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Recurrence 12 months or more after pancreatectomy was associated with a better prognosis than earlier recurrence in resected pancreatic ductal adenocarcinoma (PDAC).

Why this matters

  • Identification of a cutoff value can improve prognostic stratification in these patients.

Study design

  • Retrospective analysis of institutional database (n=957).
  • Funding: Various nonindustry sources.

Key results

  • Among 753 patients with a recurrence, 12 months was the optimal cutoff length of recurrence-free survival (RFS) based on postrecurrence survival (PRS; P=3.31×1013).
  • Early recurrence:
    • 1-year PRS, 20%.
    • 2-year PRS, 6%.
  • Late recurrence:
    • 1-year PRS, 45% (P<.001>
    • 2-year PRS, 22% (P<.001>
  • Median OS longer for late recurrence (34.6 vs 13.0 months; P<.001>
  • Preoperative risk factors for early recurrence (P=0053 to P<.001 style="list-style-type:circle;">
  • Charlson age-comorbidity index ≥4 (OR, 1.65).
  • Tumor size >3.0 cm based on computed tomography (OR, 1.53).
  • CA 19-9 >210 U/mL (OR, 2.30).
  • Postoperative risk factors for early recurrence (P=.004 to P<.001 style="list-style-type:circle;">
  • Poor tumor differentiation grade (OR, 1.66).
  • Microscopic lymphovascular invasion (OR, 1.70).
  • Lymph node ratio >0.2 (OR, 2.49).
  • Postoperative CA 19-9 >37 U/mL (OR, 3.38).
  • Factors associated with lower odds of early recurrence:
    • Adjuvant chemotherapy (OR, 0.28; P<.001>
    • Chemoradiotherapy (OR, 0.29; P<.001>
  • Limitations

    • Retrospective study.