Risk Factors for Early Recurrence of Resectable Pancreatic Cancer

Pancreatic cancer (PC) has one of the poorest prognosis among digestive cancers and is extremely difficult to cure. The current standard of care for resectable PC (RPC) involves surgery followed by adjuvant chemotherapy. However, patients often experience early recurrence (ER) following curative resection of RPC. This study aimed to evaluate the perioperative clinicopathological parameters as predictive factors for ER in patients with RPC.

In total, 303 patients who underwent pancreatectomy for RPC and upfront surgery at the Kyushu University Hospital between 2007 and 2016 were included. ER was defined as recurrence within six months postoperatively. Patients were classified into ER and non-ER groups, and their clinicopathological characteristics were compared.

Among the patients who underwent pancreatectomy, 66 (21.8%) developed ER. Univariate and multivariate analyses revealed substantially higher T3 tumor and R1 resection rates in patients in the ER group. Patients were then classified into high-risk (two risk factors), middle-risk (one risk factor), and low-risk (zero risk factors) groups. The overall survival (OS) of patients in the high-risk group (5-year OS: 6.0%) was significantly worse than that of patients in the low (5-year OS: 46.5%) and middle-risk (5-year OS: 18.8%) groups (p<0.01). Notably, a large tumor (≥25 mm in size) was an independent risk factor in R1 resection.

T3 tumors and R1 resection were independent predictive factors for ER and poor prognosis following resection. Multidisciplinary therapy should be considered for patients with RPC with T3 tumors or tumors ≥25 mm in size.