A Risk Score Model for Locoregional Recurrence Following Upfront Surgery for Pancreatic Adenocarcinoma: Implications...

Area of Science:

• Surgical Oncology
• Radiation Oncology
• Gastrointestinal Oncology

Background:

• Pancreatic adenocarcinoma presents a high risk of locoregional failure (LRF) after surgical resection.
• Identifying patients who may benefit from adjuvant therapies like postoperative radiation therapy (PORT) is crucial for improving outcomes.

Purpose of the Study:

• To identify predictors of LRF in pancreatic adenocarcinoma patients post-surgery.
• To develop a risk score model for predicting LRF.
• To evaluate the impact of PORT on LRF in different risk groups.

Main Methods:

• Retrospective review of 467 patients with stages I-III pancreatic adenocarcinoma (2005-2016).
• Univariable and multivariable analyses to identify LRF predictors in patients without PORT.
• Development of a risk score model and assessment of PORT's effect on high- and low-risk groups.

Main Results:

• Key predictors of LRF included pN+, involved/close margins, poor differentiation, and lymphovascular invasion.
• In high-risk patients, 2-year LRF was 57% without PORT vs. 32% with PORT (25% absolute benefit).
• High-risk patients had significantly lower overall survival (36%) compared to low-risk patients (67%).

Conclusions:

• A risk group classification can identify pancreatic adenocarcinoma patients at higher risk of LRF.
• These high-risk patients may benefit from PORT, warranting further validation and prospective studies.