• Leonard W F Seelen, Anne Floortje van Oosten, Lilly J H Brada, Vincent P Groot, Lois A Daamen, Marieke S Walma, Bastiaan F van der Lek, LiemMike S LMSLDepartment of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., Gijs A Patijn, StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Ronald M van Dam, KoerkampBas GrootBGDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Olivier R Busch, de HinghIgnace H J TIHJTDepartment of Surgery, Catharina Hospital, Eindhoven, The Netherlands., van EijckCasper H JCHJDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Marc G Besselink, Richard A Burkhart, Borel RinkesInne H MIHMDepartment of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands., Christopher L Wolfgang, Izaak Quintus Molenaar, Jin He, and Hjalmar C van Santvoort.
• Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands.
• Ann. Surg. 2023 Jul 1; 278 (1): 118126118-126.

ObjectiveTo establish an evidence-based cutoff and predictors for early recurrence in patients with resected locally advanced pancreatic cancer (LAPC).BackgroundIt is unclear how many and which patients develop early recurrence after LAPC resection. Surgery in these patients is probably of little benefit.MethodsWe analyzed all consecutive patients undergoing resection of LAPC after induction chemotherapy who were included in prospective databases in The Netherlands (2015-2019) and the Johns Hopkins Hospital (2016-2018). The optimal definition for "early recurrence" was determined by the post-recurrence survival (PRS). Patients were compared for overall survival (OS). Predictors for early recurrence were evaluated using logistic regression analysis.ResultsOverall, 168 patients were included. After a median follow-up of 28 months, recurrence was observed in 118 patients (70.2%). The optimal cutoff for recurrence-free survival to differentiate between early (n=52) and late recurrence (n=66) was 6 months ( P <0.001). OS was 8.4 months [95% confidence interval (CI): 7.3-9.6] in the early recurrence group (n=52) versus 31.1 months (95% CI: 25.7-36.4) in the late/no recurrence group (n=116) ( P <0.001). A preoperative predictor for early recurrence was postinduction therapy carbohydrate antigen (CA) 19-9≥100 U/mL [odds ratio (OR)=4.15, 95% CI: 1.75-9.84, P =0.001]. Postoperative predictors were poor tumor differentiation (OR=4.67, 95% CI: 1.83-11.90, P =0.001) and no adjuvant chemotherapy (OR=6.04, 95% CI: 2.43-16.55, P <0.001).ConclusionsEarly recurrence was observed in one third of patients after LAPC resection and was associated with poor survival. Patients with post-induction therapy CA 19-9 ≥100 U/mL, poor tumor differentiation and no adjuvant therapy were especially at risk. This information is valuable for patient counseling before and after resection of LAPC.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

18 keywords...

hide…