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Risk Factors for Early Disease-Related Mortality Among Patients with Localized Pancreatic Cancer Resected After
Federico De Stefano1,2, Giulio Belfiori1, Giuseppe Malleo3
1Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Annals of Surgical Oncology
|February 22, 2026
Summary
Pancreatic cancer patients with larger tumors (≥ 25 mm) or high CA19-9 levels (≥ 100 U/mL) after neoadjuvant treatment (NAT) face a higher risk of early death. These factors are crucial warning signs for surgical decisions.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pancreatic ductal adenocarcinoma (PDAC) recurrence after neoadjuvant treatment (NAT) and surgery can lead to poor survival.
- Identifying preoperative risk factors for early mortality is crucial for patient management.
Purpose of the Study:
- To identify preoperative risk factors associated with mortality within one year after NAT and radical resection for PDAC.
Main Methods:
- Retrospective analysis of 418 PDAC patients who received NAT and radical resection.
- Early-death (ED) defined as disease-related mortality within 12 months post-surgery.
- Multivariable logistic regression and ROC analysis to identify predictive factors, validated in an external cohort.
Main Results:
- 44 patients (10.5%) experienced early death (ED).
- Radiological tumor size ≥ 25 mm (OR 3.81) and CA19-9 levels ≥ 100 U/mL (OR 2.93) were independently associated with ED.
- These findings were confirmed in an external cohort of 473 patients.
Conclusions:
- Post-treatment CA19-9 levels ≥ 100 U/mL and tumor size ≥ 25 mm are significant predictors of early death after PDAC resection following NAT.
- These indicators serve as critical warning signs for surgical decision-making and preoperative patient counseling.
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