Prediction of isolated local recurrence after resection of pancreatic ductal adenocarcinoma: a nationwide study

Background: Distinguishing postoperative fibrosis from isolated local recurrence (ILR) after resection of pancreatic ductal adenocarcinoma (PDAC) is challenging. A prognostic model that helps to identify patients at risk of ILR can assist clinicians when evaluating patients’ postoperative imaging. This nationwide study aimed to develop a clinically applicable prognostic model for ILR after PDAC resection.

Methods: An observational cohort study was performed, including all patients who underwent PDAC resection in the Netherlands (2014-2019) (NCT04605237). Based on recurrence location (ILR, systemic, or both), multivariable cause-specific Cox-proportional hazard analysis was conducted to identify predictors for ILR and presented as hazard ratios (HRs) with 95% confidence intervals (CIs). A predictive model was developed using Akaike’s Information Criterion and bootstrapped discrimination and calibration indices were assessed.

Results: Amongst 1194/1693 patients (71%) with recurrence, 252 patients (21%) developed ILR. Independent predictors for ILR were resectability status (borderline versus resectable, HR1.42; 95%CI 1.03-1.96; P=0.03, and locally advanced versus resectable, HR1.11; 95%CI 0.68-1.82; P=0.66), tumor location (head versus body/tail, HR1.50; 95%CI 1.00-2.25; P=0.05), vascular resection (HR1.86; 95%CI 1.41-2.45; P<0.001), perineural invasion (HR1.47; 95%CI 1.01-2.13; P=0.02), number of positive lymph nodes (HR1.04; 95%CI 1.01-1.08; P=0.02), and resection margin status (R1<1mm versus R0≥1mm, HR1.64; 95%CI 1.25-2.14; P<0.001). Moderate performance (concordance index 0.66) with adequate calibration (slope 0.99) was achieved.

Conclusion: This nationwide study identified factors predictive of ILR after PDAC resection. Our prognostic model, available through www.pancreascalculator.com, can be utilized to identify patients with a higher a priori risk of developing ILR, providing important information in patient evaluation and prognostication.

Research authors: Iris W.J.M. van Goor, Paul C.M. Andel, Hjalmar C. van Santvoort, I. Quintus Molenaar, Martijn P.W. Intven, Lois A. Daamen
Version: 1.23
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chance of isolated local recurrence 12 months after resection of pancreatic ductal adenocarcinoma

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