title: Proposed preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after surgical resection: A multi-center retrospective study.
abstract: OBJECTIVE
  Although surgical resection remains the only chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC), postoperative early recurrence (ER) is frequently encountered. The purpose of this study is to determine the preoperative predictive factors for ER after upfront surgical resection.
  
  
  METHODS
  Between 2001 and 2012, 968 patients who underwent upfront surgery with R0 or R1 resection for PDAC at seven high-volume centers in Japan were retrospectively reviewed. ER was defined as relapse within 6 months after surgery. Study analysis stratified by resectable (R) and borderline resectable (BR) PDACs was conducted according to the National Comprehensive Cancer Network guidelines.
  
  
  RESULTS
  ER occurred in 239 patients (25%) with a median survival time (MST) of 8.8 months. Modified Glasgow prognostic score = 2 (odds ratio (OR) 2.06, 95% confidence interval (CI) 1.05-3.95; P = 0.044), preoperative CA19-9 ≥300 U/ml (OR 1.94, 1.29-2.90; P = 0.003), and tumor size ≥30 mm (OR 1.72, 1.16-2.56; P = 0.006), were identified as preoperative independent predictive risk factors for ER in patients with R-PDAC. In the R-PDAC patients, MST was 35.5, 26.3, and 15.9 months in patients with 0, 1 and ≥2 risk factors, respectively. There were significant differences in overall survival between the three groups (P < 0.001). No preoperative risk factors were identified in BR-PDAC patients with a high rate of ER (39%).
  
  
  CONCLUSIONS
  There is a high-risk subset for ER even in patients with R-PDAC and a simple risk scoring system is useful for prediction of ER.
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan. Electronic address: ippeimm@gmail.com.
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Institute of Biomedical and Health Sciences, Department of Surgery, Hiroshima University, Hiroshima, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Shinzeki
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Sadaki
authors.initials: S
authors.lastname: Asari
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan.
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Institute of Biomedical and Health Sciences, Department of Surgery, Hiroshima University, Hiroshima, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uemura
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Nara Medical University, Nara, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sho
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Kansai Medical University, Hirakata, Japan.
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Honda
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Nara Medical University, Nara, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Akahori
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Kansai Medical University, Hirakata, Japan.
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Masanao
authors.initials: M
authors.lastname: Kurata
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.affiliation: Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D016017:Odds Ratio; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Early recurrence; Multi-center study; Pancreatic cancer; Pancreatic ductal adenocarcinoma; Preoperative risk factor; Resectable pancreatic cancer