Appraisal of 5‐year recurrence‐free survival after surgery in pancreatic ductal adenocarcinoma

Abstract

Background/Purpose Pancreatic ductal adenocarcinoma (PDAC) is regarded as incurable, with a limited survival rate after curative resection. The aim of this study was to explore long‐term survival and late recurrence of PDAC after surgery. Methods Medical data of 859 patients who underwent resection between 1995 and 2014 were retrospectively examined. The clinicopathological features of the 5‐year recurrence‐free survivors and the patients with recurrent disease after 5 years were investigated separately. Results Among the 768 patients who were finally included in this study, elevated CA 19‐9, tumor size, poor differentiation, and positive lymph node metastasis were associated with recurrence. In 89 patients with 5‐year RFS, age, tumor size, differentiation, and lymph node metastasis were statistically significant predictive factors. Among these patients, disease relapse occurred in 11 patients; age was the only difference compared to those who remained free of recurrence. Conclusions Most prognosticators failed to predict the risk of recurrence in the 5 years following surgery for PDAC, and recurrence can occur even at time points up to 100 months. Therefore, cure of PDAC cannot be guaranteed by a 5‐year recurrence‐free interval, and further studies into the inherent nature of PDAC are needed to develop adequate surveillance systems which may lead to improvements in survival.

Development of Nomograms for Predicting Prognosis of Pancreatic Cancer after Pancreatectomy: A Multicenter Study

“…Elevated NLR was shown to predict a poor prognosis in some studies [ 6 ]; however, only PLR was a significant risk factor in other studies [ 7 ]. In our previous single institutional study, both NLR and PLR were associated with the OS of patients with resected PDAC [ 2 ]. In the present study based on multi-center data, only PLR was significantly associated with RFS.…”

“…The only curative treatment is surgical resection. As reported in recent studies, five-year survival for patients with resected PDAC has increased up to 17% [ 2 ]. The most widely accepted method for predicting survival outcomes after surgery is the American Joint Committee on Cancer (AJCC) system, consisting of tumor extent (T stage), lymph node status (N stage), and distant metastasis (M stage) (TNM staging) [ 3 ].…”

“…Intraoperatively, estimated blood loss (EBL) and transfusion have been reported as independent risk factors for survival [ 9 ]. In terms of pathologic features, lymph node ratio (LNR) and resection margin status are considered potentially associated with outcomes of patients with resected PDAC [ 2 , 10 , 11 ].…”

A Novel DNA Replication-Related Signature Predicting Recurrence After R0 Resection of Pancreatic Ductal Adenocarcinoma: Prognostic Value and Clinical Implications

“…However, even if R0 resection is achieved, more than half of patients subsequently experience local recurrence or distant metastases within 2 years of surgery ( Kim et al, 2017 ; Strobel et al, 2017 ; Ghaneh et al, 2019 ; Tummers et al, 2019 ). Clinical features including but not limited to tumor size and tumor grade have been associated with tumor recurrence ( Abe et al, 2020 ; Kim et al, 2020 ; Yoon et al, 2020 ); nevertheless, their predictive ability was not always satisfactory in R0-treated patients. Effective prediction of recurrence may help to tailor adjuvant chemotherapy and postoperative surveillance in this subgroup of patients.…”

Pathological Nodal and Vascular Involvement Significantly Impacts the Recurrence Risk in Different Time Frames in Patients With Resectable and Borderline Resectable Pancreatic Cancer

“…1,2 In this context, prognostic analyses in patients with pancreatic cancer (PC) who received various treatments, including pancreatectomy, have been conducted. [3][4][5][6] However, significant limitations have been noted in the conventional prognostic evaluation: a high frequency of poor prognostic factors was observed even in the subgroup of longterm survivors. 3,4,7,8 Indeed, Strobel et al reported that 63% of 5-year survivors were positive for nodal status, which is a wellknown poor prognostic variable in PC.…”