Quantitative definitions of pain, CA19-9, and tumor size as high-risk features of resectable pancreatic cancer: a single-center retrospective cohort study

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of malignant tumors with the worst prognosis. Surgery and adjuvant chemotherapy are the main treatments for resectable pancreatic cancer. For borderline resectable PDAC, neoadjuvant chemotherapy has been advised. For clearly resectable PDAC, neoadjuvant chemotherapy also might be considered for the patients with high-risk features, but with no precise quantitative criteria to define these features. So, this study aimed to re-evaluate the relationship between high-risk features and prognosis of clearly resectable pancreatic cancer, and to define the precise criteria for these high-risk features.Methods: Data from 211 patients with clearly resectable pancreatic cancer were reviewed to assess the relationship between overall survival (OS) after surgery and high-risk features, and cut-off values were determined for high-risk features that were associated with poor prognosis of clearly resectable pancreatic cancer.Results: Lymph node metastasis (LNM), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and primary tumor size ≥6 cm were significant variables related to OS. CA19-9 ≥1,000 U/mL was statistically related to prognosis, as was CA19-9 ≥500 U/mL without obstructive jaundice. There was no significant relationship between abdominal and/or back pain and OS, but patients with moderate or severe pain accompanied by tumor size ≥4 cm or 10 times higher CA19-9 levels had worse prognosis.Conclusions: For clearly resectable pancreatic cancer with R0 resection, the high-risk features were clarified. Abdominal and/or back pain may not be used as a prognostic indicator alone, though combined with CA19-9 or tumor size it may be more valuable for predicting prognosis.

Magnetic Resonance Imaging Radiomics‐Based Nomogram From Primary Tumor for Pretreatment Prediction of Peripancreatic Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma: A Multicenter Study

“…Compared with the model built by Ning Pu et al, 3 the radiomics‐based preoperative and postoperative nomograms have stronger predictive power for peripancreatic LN metastasis, which indicated that intratumor imaging features other than tumor size could also be the candidate predictor for LN metastasis. Besides the tumor size, some other clinicopathologic indicators correlated with a poor prognosis of PDAC, including serum CA199 and tumor differentiation degree, have been reported by previous works of literature, 3,15,16,40,41 which also were verified in this study.…”

“…Primary pancreatic tumor size is an independent predictor of peripancreatic LN metastasis in PDAC patients 3,29,40 . Nevertheless, the risk of peripancreatic LN metastasis varies for pancreatic tumors with the same size, from 0.1 to 4 cm, and it is still controversial as to whether the size of small primary tumors has significant correlation with the risk of LN metastasis 3 .…”

Adjusting CA19-9 values with clinical stage and bilirubin to better predict survival of resectable pancreatic cancer patients: 5-year-follow-up of a single center

“…To reduce the effect of biliary blockage on CA19-9, Zhao et al developed a correction formula for CA19-9 following bile duct draining (13). Xu et al found that tumor volume influenced CA19-9, and that volumecorrected CA19-9 may be employed as an independent risk factor influencing PDAC prognosis (14). It is apparent that utilizing more sophisticated formulas or adding more markers may increase predictive accuracy, but whether this is beneficial for clinical usage and popularization is debatable.…”

Regional lymph node metastasis detected on preoperative CT and/or FDG-PET may predict early recurrence of pancreatic adenocarcinoma after curative resection

“…Regional LN metastasis indicates a high risk of disseminated disease and has been identified as a risk factor for early recurrence after surgical resection 11 – 14 . However, the impact of preoperatively diagnosed regional LN metastasis on early recurrence has been seldom reported with conflicting results 15 – 17 . As such, the clinical implications of regional LN metastasis identified on preoperative computed tomography (CT) or 18 F-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) scans remain controversial 2 , 4 , 18 .…”