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Combined Preoperative Risk Score Including sCD40, Leukocytes, and BMI Predicts Pancreas-Specific Complications After
Loreen Natusch Bufe1,2,3,4, Marie Crede5, David Digomann1,2,3,4
1Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Annals of Surgical Oncology
|May 2, 2026
Summary
Reduced preoperative soluble CD40 (sCD40) levels predict pancreas-specific complications after pancreaticoduodenectomy (PD) in pancreatic cancer patients. Combining sCD40 with leukocytes and BMI may improve risk assessment for these critical outcomes.
Area of Science:
- Surgical Oncology
- Biomarker Discovery
- Pancreatic Cancer Research
Background:
- Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, necessitating effective treatments.
- Surgical resection is the only curative option, but postoperative complications like pancreatic fistula (POPF) and hemorrhage (PPH) hinder treatment.
- Predictive biomarkers for these complications are currently lacking.
Purpose of the Study:
- To investigate soluble CD40 (sCD40) as a predictive biomarker for POPF and PPH after pancreatoduodenectomy (PD) in PDAC patients.
- To assess the potential of sCD40 in conjunction with other clinical factors for improved risk stratification.
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) was used to quantify preoperative serum sCD40 levels in 185 PDAC patients.
- Patients underwent either pylorus-preserving PD or Whipple procedure.
- Clinical and postoperative outcomes, including POPF and PPH, were systematically collected and analyzed.
Main Results:
- Lower preoperative sCD40 levels were significantly associated with an increased risk of POPF (P=0.025) and PPH (P=0.008).
- This association remained significant in multivariable analysis.
- Incorporating leukocytes and body mass index (BMI) with sCD40 improved the predictive performance for POPF (AUC=0.705) and PPH (AUC=0.752).
Conclusions:
- Reduced preoperative serum sCD40 levels are a significant predictor of POPF and PPH following PD.
- The combination of sCD40, leukocytes, and BMI offers a promising approach for enhanced preoperative risk assessment in PDAC patients.
- This finding could aid in optimizing patient management and potentially improve outcomes after pancreatic surgery.
