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Updated: Jul 14, 2026
An Orthotopic Resectional Mouse Model of Pancreatic Cancer
Published on: September 24, 2020
Preoperative predictors of early recurrence after neoadjuvant gemcitabine plus S-1 in resectable pancreatic cancer: a
Yoshihiro Shirai1, Ryoga Hamura2,3, Masashi Tsunematsu3
1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan. shirai@jikei.ac.jp.
Purpose:
Pancreatic ductal adenocarcinoma (PDAC) frequently recurs early after resection, resulting in a poor prognosis. Although neoadjuvant chemotherapy with gemcitabine plus S-1 (NAC-GS) is the standard strategy in Japan, predictors of early recurrence (ER) remain unclear.
Methods:
We retrospectively analyzed 102 patients with resectable pancreatic ductal adenocarcinoma (PDAC) who underwent NAC-GS followed by pancreatectomy at four institutions. ER was defined as recurrence within 6 months of surgery. Clinicopathological variables were evaluated to identify the predictors of ER.
Results:
ER occurred in 9% of patients and was independently associated with significantly worse overall survival. Tumor progression during NAC-GS and elevated pre-treatment CA19-9 levels (> 292 U/mL) were identified as independent preoperative predictors of ER. A novel scoring system incorporating these factors effectively stratified ER risk (ER rates: 1%, 13%, and 100% for scores of 0, 1, and 2, respectively; AUC = 0.85). The score was also associated with the long-term prognosis.
Conclusion:
Tumor progression during NAC-GS and elevated CA19-9 levels are significant predictors of ER in patients with resectable PDAC. The proposed scoring system may aid in identifying patients who could benefit from alternative or intensified treatment strategies.