Abstract
Background The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma (PDAC) recurrence are unclear. This study attempted to identify the predictive factors for early PDAC recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy.
Methods One hundred and fifteen patients undergoing curative resection for PDAC between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did and did not experience PDAC recurrence within 6 months postoperatively.
Results Thirty-four (30%) patients experienced early recurrence. Multivariate analyses demonstrated postoperative carbohydrate antigen 19-9 (CA19-9) de-normalization, no postoperative adjuvant chemotherapy (ACT), and serosal invasion were independent risk factors for early recurrence (P<0.001, P=0.001, and P=0.010, respectively). A subgroup analysis showed patients with (n=51) and without (n=64) preoperative chemoradiotherapy (CRT) had different predictors. Although postoperative ACT was not a significant indicator in patients with preoperative CRT, CA19-9 de-normalization and no postoperative ACT were significant indicators in patients without preoperative CRT. Preoperative CRT strongly prevented early local recurrence while postoperative ACT prevented early distant recurrence.
Conclusions CA19-9 de-normalization was an important predictor of early recurrence of PDAC. Although postoperative ACT was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative CRT might compensate for a lack of postoperative ACT. Preoperative CRT could strongly prevent the early local recurrence of PDAC. These perioperative adjuvant therapies could have a complementary relationship.
A combination of platelet-to-lymphocyte ratio and carbohydrate antigen 19-9 predict early recurrence after resection of pancreatic ductal adenocarcinoma
