• Iris W J M van Goor, Thijs J Schouten, Daphne N Verburg, Marc G Besselink, Bert A Bonsing, Koop Bosscha, BrosensLodewijk A ALAADepartment of Pathology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands., Olivier R Busch, Geert A Cirkel, Ronald M van Dam, Sebastiaan Festen, KoerkampBas GrootBGDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Erwin van der Harst, de HinghIgnace H J TIHJTDepartment of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Martijn P W Intven, Geert Kazemier, Maartje Los, Gert J Meijer, Vincent E de Meijer, Vincent B Nieuwenhuijs, Daphne Roos, SchreinemakersJennifer M JJMJDepartment of Surgery, Amphia Hospital, Breda, the Netherlands., StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands., Robert C Verdonk, Hjalmar C van Santvoort, Lois A Daamen, I Quintus Molenaar, and Dutch Pancreatic Cancer Group.
• Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands.
• Ann. Surg. 2024 Jan 1; 279 (1): 132137132-137.

ObjectiveTo develop a prediction model for long-term (≥5 years) disease-free survival (DFS) after the resection of pancreatic ductal adenocarcinoma (PDAC).BackgroundDespite high recurrence rates, ~10% of patients have long-term DFS after PDAC resection. A model to predict long-term DFS may aid individualized prognostication and shared decision-making.MethodsThis nationwide cohort study included all consecutive patients who underwent PDAC resection in the Netherlands (2014-2016). The best-performing prognostic model was selected by Cox-proportional hazard analysis and Akaike's Information Criterion, presented by hazard ratios (HRs) with 95% confidence intervals (CIs). Internal validation was performed, and discrimination and calibration indices were assessed.ResultsIn all, 836 patients with a median follow-up of 67 months (interquartile range 51-79) were analyzed. Long-term DFS was seen in 118 patients (14%). Factors predictive of long-term DFS were low preoperative carbohydrate antigen 19-9 (logarithmic; HR 1.21; 95% CI 1.10-1.32), no vascular resection (HR 1.33; 95% CI 1.12-1.58), T1 or T2 tumor stage (HR 1.52; 95% CI 1.14-2.04, and HR 1.17; 95% CI 0.98-1.39, respectively), well/moderate tumor differentiation (HR 1.44; 95% CI 1.22-1.68), absence of perineural and lymphovascular invasion (HR 1.42; 95% CI 1.11-1.81 and HR 1.14; 95% CI 0.96-1.36, respectively), N0 or N1 nodal status (HR 1.92; 95% CI 1.54-2.40, and HR 1.33; 95% CI 1.11-1.60, respectively), R0 resection margin status (HR 1.25; 95% CI 1.07-1.46), no major complications (HR 1.14; 95% CI 0.97-1.35) and adjuvant chemotherapy (HR 1.74; 95% CI 1.47-2.06). Moderate performance (concordance index 0.68) with adequate calibration (slope 0.99) was achieved.ConclusionsThe developed prediction model, readily available at www.pancreascalculator.com, can be used to estimate the probability of long-term DFS after resection of pancreatic ductal adenocarcinoma.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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