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Predictive Nomogram for Recurrence After Upfront Surgery for Resectable Pancreatic Ductal Adenocarcinoma: A
Ryuichi Yoshida1, Kosei Takagi1, Kazuya Yasui1
1Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Cancers
|April 14, 2026
Summary
This study developed a recurrence prediction model for pancreatic cancer patients after surgery. Early recurrence, defined as occurring within five months, was predicted by high CA 19-9 levels.
Area of Science:
- Oncology
- Surgical Oncology
- Cancer Prognostics
Background:
- Postoperative recurrence significantly impacts survival in resectable pancreatic ductal adenocarcinoma (rPDAC).
- Early recurrence after upfront surgery (UFS) is associated with extremely poor prognosis.
- Accurate prediction of recurrence and definition of early recurrence are crucial for rPDAC management.
Purpose of the Study:
- To develop a predictive model for recurrence in patients with rPDAC undergoing UFS.
- To establish a clear definition for early recurrence following UFS for rPDAC.
Main Methods:
- A multicenter retrospective study involving 603 patients who underwent UFS for rPDAC.
- Multivariate analyses were performed to identify independent risk factors for recurrence-free survival.
- A minimum p-value approach was utilized to determine the optimal cutoff for early vs. late recurrence.
Main Results:
- Independent predictors of recurrence included elevated carbohydrate antigen 19-9 (≥37 U/mL), larger tumor size (≥2.2 cm), lymph node metastasis, R1 resection, and absence of adjuvant chemotherapy.
- The developed recurrence prediction model showed an area under the curve of 0.72-0.75.
- A recurrence-free interval of five months was identified as the optimal threshold for early recurrence, with CA 19-9 ≥ 156 U/mL predicting early recurrence (OR, 3.28).
Conclusions:
- Key prognostic risk factors for recurrence after UFS in rPDAC were identified.
- A validated recurrence prediction model was developed for rPDAC patients.
- A recurrence-free interval of five months serves as a critical threshold to differentiate early from late recurrence.
