title: Is a preoperative assessment of the early recurrence of pancreatic cancer possible after complete surgical resection?
abstract: OBJECTIVE
  The prognosis of pancreatic adenocarcinoma (PAC) is poor. The serum carbohydrate antigen 19-9 (CA 19-9) level has been identified as a prognostic indicator of recurrence and reduced overall survival. The aim of this study was to identify preoperative prognostic factors and to create a prognostic model able to assess the early recurrence risk for patients with resectable PAC.
  
  
  METHODS
  A series of 177 patients with PAC treated surgically at the St. Andrea Hospital of Rome between January 2003 and December 2011 were reviewed retrospectively. Univariate and multivariate analyses were utilized to identify preoperative prognostic indicators.
  
  
  RESULTS
  A preoperative CA 19-9 level >228 U/mL, tumor size >3.1 cm, and the presence of pathological preoperative lymph nodes statistically correlated with early recurrence. Together, these three factors predicted the possibility of an early recurrence with 90.4% accuracy. The combination of these three preoperative conditions was identified as an independent parameter for early recurrence based on multivariate analysis (p=0.0314; hazard ratio, 3.9811; 95% confidence interval, 1.1745 to 15.3245).
  
  
  CONCLUSIONS
  PAC patient candidates for surgical resection should undergo an assessment of early recurrence risk to avoid unnecessary and ineffective resection and to identify patients for whom palliative or alternative treatment may be the treatment of choice.
authors: Department of General Surgery, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Marco
authors: M
authors: La Torre
authors: Department of Hepato-Biliary and Pancreatic Surgery, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Giuseppe
authors: G
authors: Nigri
authors: Department of General Surgery, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Annalisa
authors: A
authors: Lo Conte
authors: Department of Oncology, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Federica
authors: F
authors: Mazzuca
authors: Department of General Surgery, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Simone Maria
authors: SM
authors: Tierno
authors: Department of General Surgery, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Adelona
authors: A
authors: Salaj
authors: Department of Oncology, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Paolo
authors: P
authors: Marchetti
authors: Department of General Surgery, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Vincenzo
authors: V
authors: Ziparo
authors: Department of Hepato-Biliary and Pancreatic Surgery, Biomedical Technologies and Translational Medicine, St. Andrea Hospital, University of Rome La Sapienza Faculty of Medicine and Psychology, Rome, Italy.
authors: Giovanni
authors: G
authors: Ramacciato
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen
keywords: Early recurrence; Pancreatic adenocarcinoma; Pancreatic neoplasms; Preoperative CA 19-9; Prognosis