Identification of Preoperative Risk Factors for Poor Survival in Patients with Resectable Pancreatic Cancer Treated with Upfront Surgery

Abstract

<b><i>Introduction:</i></b> The aim of this study was to identify preoperative risk factors for poor survival in patients with resectable pancreatic ductal adenocarcinoma (PDAC) treated with upfront surgery. <b><i>Methods:</i></b> Medical records of 268 patients with resectable PDAC defined by resectability status who underwent upfront surgery were reviewed retrospectively. Multivariate analyses were performed to identify preoperative risk factors for recurrence-free survival (RFS) and overall survival (OS). Moreover, a binary logistic regression model was built to determine preoperative independent risk factors of 2- and 3-year recurrence and survival. <b><i>Results:</i></b> Multivariate analyses identified CA19-9 (≥100 U/mL, <i>p</i> < 0.001) as an independent risk factor for poor RFS, and worse performance status (1 or 2, <i>p</i> = 0.03), platelet:lymphocyte ratio (<150, <i>p</i> = 0.04), and preoperative CA19-9 (≥100 U/mL, <i>p</i> < 0.001) as independent risk factors for poor OS. Moreover, preoperative CA19-9 (≥100 U/mL) was the only independent risk factor identified for 2- and 3-year recurrence and survival. <b><i>Discussion/Conclusion:</i></b> Preoperative CA19-9 (≥100 U/mL) was the most reliable preoperative predictive factor for poor survival in resectable PDAC treated with upfront surgery. These findings warrant further clinical trials investigating efficacy of neoadjuvant therapy targeting the subset of patients with resectable PDAC who have elevated preoperative CA19-9, namely, those with high risk of poor prognosis.

The enigmatic helicase DHX9 as a candidate prognostic biomarker for resected pancreatic ductal adenocarcinoma

“…Although great advancements in treatment strategies for cancers including chemotherapy, radiotherapy, and immunotherapy have been realized, the improvements in PDAC treatment remain at a low speed ( 2 ). Surgical resection remains the only potential treatment to cure PDAC now, but the survival of PDAC patients receiving radical resection is still unsatisfactory ( 3 ). Thus, it is necessary to investigate novel biomarkers and potential targets for treatment that are highly efficient and technically feasible to predict the prognosis of radically resected PDAC patients and develop novel therapeutic strategies.…”

Clinical Utility of the Combined Use of CA19-9 and DUPAN-2 in Pancreatic Adenocarcinoma

“…Several previous reports have demonstrated original institutional cutoff values of CA19-9 and DUPAN-2 to predict the prognosis of PDAC. 9 , 16 , 17 These cutoff values were clinically important in each institution; however, it is unclear which cutoff value is the most appropriate. Whether these values are equally useful in all institutions is also a concern.…”

Letter to “Identification of Pre-Operative Risk Factors for Poor Survival in Patients with Resectable Pancreatic Cancer Treated with Upfront Surgery”

“…Dear Editor, We read with great interest the article "Identification of Preoperative Risk Factors for Poor Survival in Patients with Resectable Pancreatic Cancer Treated with Upfront Surgery" authored by Kondo et al [1], published recently in your esteemed journal. We would like to congratulate the authors on such an outstanding study to address the issue and attempt to objectify the high-risk factors for poor survival [1].…”